Red blood cell transfusion support and management of secondary iron overload in patients with haematological malignancies in the Netherlands: a survey

Hoeks, Marlijn; Middelburg, Rutger A.; Romeijn, Bas; Blijlevens, Nicole M A; Kraaij, M.G.J. van; Zwaginga, Jaap‐Jan

doi:10.1111/vox.12617

Cited by 8 publications

(12 citation statements)

References 30 publications

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“…Several RBC transfusions could bring iron overload since there are no available physiological pathways eliminating excess iron stored in the reticuloendothelial and endocrine systems as well as in the liver and heart 20 . Another study demonstrated that decreased RBC counts were associated with reduced complications related to transfusion as secondary iron overload 21 . The essential effects of decreased HGB level on the assessment of iron overload patients were also previously reported 22 .…”

Section: Discussionmentioning

confidence: 81%

“…In a previous study conducted by Chai 20 Another study demonstrated that decreased RBC counts were associated with reduced complications related to transfusion as secondary iron overload. 21 The essential effects of decreased HGB level on the assessment of iron overload patients were also previously reported. 22 The study found that the iron overload could promote the level of serum ferritin.…”

Section: Allo-hsct In An Iron-overloaded Mice Negatively Impacts Sumentioning

confidence: 74%

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Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Lin

Chen

et al. 2020

The Kaohsiung J of Med Scie

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Hematological malignancies are increasingly treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, iron overload is a frequent adverse effect of allo-HSCT and is associated with poor prognosis. In the present study, we investigated hematopoiesis in iron-overloaded mice and elucidated the effects of iron overload on the bone marrow (BM) microenvironment. Ironoverloaded BALB/C mice were generated by injecting 20 mg/mL saccharated iron oxide intraperitoneally. Hematoxylin-eosin staining was performed to evaluate the effects of an iron overload in mice. BM cells obtained from C57BL/6 mice were transplanted into irradiated BALB/C mice (whole-body irradiation of 4 Gy, twice with a 4-hours interval) by tail vein injection. Two weeks after allo-HSCT, the hematopoietic reconstitution capacity was evaluated in recipients by colony-forming assays. Histopathological examinations showed brown-stained granular deposits, irregularly arranged lymphocytes in the liver tissues, and blue-stained blocks in the BM collected from mice received injections of high-dose saccharated iron oxide (20 mg/mL). Ironoverloaded mice showed more platelets, higher-hemoglobin (HGB) concentration, fewer granulocyte-macrophage colony-forming units (CFU-GM), erythrocyte colonyforming units (CFU-E), and mixed granulocyte/erythrocyte/monocyte/megakaryocyte colony-forming units (CFU-mix) than healthy mice. Iron-overloaded recipients presented with reduced erythrocytes and HGB concentration in peripheral blood, along with decreased marrow stroma cells, CFU-GM, CFU-E, and CFU-mix relative to healthy recipients. Taken together, our findings demonstrate that iron overload might alter the number of red blood cells after transplantation in mice by destroying the

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Section: Discussionmentioning

confidence: 81%

Section: Allo-hsct In An Iron-overloaded Mice Negatively Impacts Sumentioning

confidence: 74%

Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Lin

Chen

et al. 2020

The Kaohsiung J of Med Scie

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“…There are no clearly defined red blood cell (RBC) transfusion thresholds for outpatients with MDS 6,7 . Surveys of hematologists show a wide variation in transfusion practices for outpatients with hematologic malignancy, although many use a threshold of <80 g/L 8–10 . However, we have limited information on what thresholds are used in clinical practice when managing patients with MDS.…”

Section: Introductionmentioning

confidence: 99%

Multi‐national survey of transfusion experiences and preferences of patients with myelodysplastic syndrome

et al. 2022

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Background: Transfusion dependence on red blood cells (RBCs) is common for patients with myelodysplastic syndromes (MDS) but transfusion practice and experience for outpatients with MDS are largely unknown. Methods: We conducted a web-based cross-sectional multi-national survey to audit real-world transfusion practices and understand the experiences and preferences of patients with MDS requiring RBC transfusion. The survey comprised 57 questions and was distributed to patients in the United States of America, Canada, and the United Kingdom. Results: 447 respondents (45% female) with a median age of 72 years (IQR 66-77) were eligible on the basis of receiving an RBC transfusion in the last 8 weeks. There was wide variability in the hemoglobin thresholds for transfusion with the most common being <80 g/L. 40% of patients were transfused at a lower threshold (<70-75 g/L), with the largest proportion of these patients from the United States. Patients experienced significant symptoms prior to receiving a transfusion with fatigue and dyspnea having the most negative impacts on quality of life. Finally, patients endorsed two potential alterations to transfusion care that could improve their quality of life, including self-administered point of care testing of hemoglobin and higher hemoglobin transfusion thresholds. Of these patients, 62% preferred a threshold of at least 85 g/L, and 20% preferred a threshold of at least 100 g/L. Discussion: In summary, this multi-national survey of patients with MDS requiring RBC transfusions demonstrated substantial variation in patients' experiences and preferences that differed also by country, supporting the need for further comparative clinical trials of transfusion practice interventions.

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“…A survey looking into the transfusion thresholds of patients with haematological malignancies in general in the Netherlands yielded similar results [29]. However, the median threshold for outpatient care was lower—7.2 g/dl.…”

Section: Discussionmentioning

confidence: 79%

Clinical practice for outpatients that are chronically red cell dependent: A survey in the Netherlands

2021

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Background and Objectives: Limited data are available to guide physicians on how to determine the red blood cell (RBC) transfusion regimen in chronically transfusiondependent patients. The lack of clarity on thresholds and targets to be used for transfusion could easily result in either under or over transfusion in these patients. The aim of our survey is to investigate (1) transfusion thresholds; (2) number of RBC units given per transfusion episode; (3) interval between transfusions and (4) patient factors, like decreased cardiac function modulating the former. Materials and Methods:We sent a web-based 44-question survey to members of the Dutch Haematology Association.Results: Fifty physicians responded between June and October 2020 (response rate 30%), well-distributed between community and academic hospitals. A wide variation in transfusion strategies was reported: Most patients have transfused 1-2 RBC units (range: 0-3 units) every 2-4 weeks (range: 1-12 weeks) with a median threshold of 8.0 g/dl ranging from 6.4 to 9.6 g/dl. Patient-specific clinical factors that are most frequently reported to influence the transfusion strategy are angina pectoris, cardiac failure and dyspnoea, softer parameters that are of influence are the quality of life and self-sustainability. Conclusion:The results of this survey indicate a broad variation in RBC transfusion strategies in Dutch patients with chronic transfusion dependency. While the current variation in transfusion strategies may be unavoidable in an individualized approach, randomized trials and better defined usable parameters to evaluate the effect of transfusion strategies are required to reach a consensus on how to determine the transfusion strategy.chronic anaemia, patient blood management, red blood cell transfusion, survey, transfusion dependency Highlights• Great variability in transfusion strategies for chronic anaemic patients was found.• Parameters associated with changes in transfusion strategies, like angina pectoris and selfsustainability, are identified.• The outcomes allows professionals to benchmark their transfusion strategies and practices and reflect on them, and can be used in training.

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Red blood cell transfusion support and management of secondary iron overload in patients with haematological malignancies in the Netherlands: a survey

Cited by 8 publications

References 30 publications

Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Multi‐national survey of transfusion experiences and preferences of patients with myelodysplastic syndrome

Clinical practice for outpatients that are chronically red cell dependent: A survey in the Netherlands

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