Implementation of a patient blood management program in hematopoietic stem cell transplantation (Editorial, p. 2763)

Abstract

BACKGROUND: Recipients of hematopoietic stem cell transplantation (HSCT) are among the highest consumers of allogeneic red blood cell (RBC) and platelet (PLT) components. The impact of patient blood management (PBM) efforts on HSCT recipients is poorly understood. STUDY DESIGN AND METHODS:This observational study assessed changes in blood product use and patient-centered outcomes before and after implementing a multidisciplinary PBM program for patients undergoing HSCT at a large academic medical center. The pre-PBM cohort was treated from January 1 through September 31, 2013; the post-PBM cohort was treated from January 1 through September 31, 2015. RESULTS:We identified 708 patients; 284 of 352 (80.7%) in the pre-PBM group and 225 of 356 (63.2%) in the post-PBM group received allogeneic RBCs (p < 0.001). Median (interquartile range [IQR]) RBC volumes were higher before PBM than after PBM (3 [2-4] units vs. 2 [1-4] units; p = 0.004). A total of 259 of 284 pre-PBM patients (91.2%) and 57 of 225 (25.3%) post-PBM patients received RBC transfusions when hemoglobin levels were more than 7 g/dL (p < 0.001). The median (IQR) PLT transfusion quantities was 3 (2-5) units for pre-PBM patients and 2 (1-4) units for post-PBM patients (p < 0.001). For patients with PLT counts of more than 10 × 10 9 /L, a total of 1219 PLT units (73.4%) were transfused before PBM and 691 units (48.8%) were transfused after PBM (p < 0.001). Estimated transfusion expenditures were reduced by $617,152 (18.3%). We noted no differences in clinical outcomes or transfusion-related adverse events. CONCLUSION: Patient blood management implementation for HSCT recipients was associated with marked reductions in allogeneic RBC and PLT transfusions and decreased transfusion-related costs with no detrimental impact on clinical outcomes.A llogeneic blood transfusion is the most common procedure performed in the United States, 1 but many transfusion episodes are inconsistent with evidence-based guidelines. With increased recognition of the potential for patient harm and excessive health care costs associated with inappropriate transfusion practices, many institutions have attempted to reduce non-evidencebased transfusion episodes. Formal, multidisciplinary programs for patient blood management (PBM), designed with the primary objective of optimizing patients' blood health, 2-11 have also been associated with reduced blood product use. In ABBREVIATIONS: HSCT = hematopoietic stem cell transplantation; ICU = intensive care unit; IQR = interquartile range; PBM = patient blood management.From the

The pillars of patient blood management: key to successful implementation (Article, p. 2840)

“…Warner et al were thorough in this area, fulfilling their objective of “acquisition, aggregation, and presentation, of highly granular data.” Data collected included number of products administered, laboratory values at the time of transfusion, and deviations from institutional transfusion guidelines. The aforementioned computerized decision support tool also tracked ordering provider, which permitted monitoring of adherence to the transfusion guidelines.…”

“…In this issue of Transfusion , Warner et al detail their journey toward implementing a PBM program in the challenging arena of hematopoietic stem cell transplantation (HSCT) . As mentioned above, PBM has shown efficacy in many clinical settings.…”

“…Furthermore, the Patient Blood Management 2018 Frankfurt Consensus Conference specifically listed patients with hematologic malignancies as an area in need of further study . Warner et al based their PBM program on three key activities: Educating providers on the importance of minimizing allogeneic transfusion and increasing blood health. Implementing evidence‐based guidelines and developing electronic decision support systems to direct appropriate transfusion. Developing a transfusion data analytics platform to monitor patterns in transfusion‐practices and recognize areas for improvement. …”

Patient blood management in oncology in the Russian Federation: resolution to improve oncology care.

“…Приверженность рекомендациям по рестриктивным переливаниям крови и внедрение программы МКП имеют высокий потенциал сокращения переливаний тромбоцитов. Как установлено, подобные меры сокращают использование тромбоцитов для переливания на 27-43% в масштабах системы здравоохранения, оказывая также положительное влияние на показатели эффективности лечения пациентов [34,116].…”

Hepatitis E virus in hematopoietic stem cell transplant recipients: A systematic review

“…In allo-HSCT recipients, progression to chronic infection may be favored by the severity of immunosuppression, which results in impaired immune reconstitution, including insufficient lymphocyte recovery, that are risk factors for post-transplantation infections [24][25][26]. Moreover, HSCT recipients have a high transfusion burden, which is a problem particularly in countries that have not introduced HEV screening in blood donations [22,27,28].…”