Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies

Abstract

BACKGROUND Recent recommendations indicate that one red blood cell (RBC) unit should be transfused at a time, with reassessment after each transfusion, which may be extrapolated from literature supporting restrictive transfusion triggers rather than specific evidence. Therefore, two systematic reviews were performed to identify the following: 1) RBC transfusion guidelines and review articles to determine if single‐ or multiple‐unit transfusion strategies are recommended and 2) studies comparing strategies for evidence of benefit. STUDY DESIGN AND METHODS MEDLINE, EMBASE, CINAHL, Web of Science, National Guideline Clearinghouse, and Trip Database were searched (inception to June 2017). For the first review, the proportion of articles with single/multiple‐unit recommendations was assessed and stratified by article type. For the second review, the primary outcome was RBC use. Secondary outcomes included proportion of transfusion episodes using a single‐unit strategy, length of stay, and mortality. RESULTS The first review identified 145 articles for analysis, with 51 transfusion guidelines. Only 14 guidelines (27%) made a recommendation, with most (93%) recommending single‐unit transfusions. The second review identified seven cohort studies comparing preimplementation and postimplementation of a policy encouraging single‐unit transfusion strategies. Meta‐analysis could not be performed for outcomes given inconsistencies in reporting. RBC use decreased by approximately 10 to 41% across studies. CONCLUSION Transfusion guidelines lack recommendations to transfuse to a single‐unit strategy. Mostly retrospective cohort studies (six of seven) are inconsistent in outcome reporting but suggest improved RBC use. Further high‐quality studies could identify the benefits of a single‐unit transfusion strategy, determine the applicability to different clinical settings, and inform future practice guidelines.

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

“…Single-unit transfusion constitutes part of restrictive transfusion strategies and is a cornerstone of patient blood management (PBM). Despite the absence of a high level of evidence, single-unit transfusion is included in the majority of guidelines [52]. The benefit of this type of transfusion practice is supported by a number of factors.…”

Safety and efficacy of a Hb‐triggered single‐unit red cell transfusion policy for haemato‐oncological inpatients

“…Notwithstanding, this does not imply a general inefficacy of single-unit transfusion episodes, as an abundant number of studies performed in varying patient cohorts consistently demonstrated a strong reduction of up to 40% in RBC use after changing to single-unit transfusion practices. 6,8,10,11 Analysis of predefined safety parameters did not demonstrate any change in duration of admission, duration of neutropenia, 30-day mortality, number of platelet transfusions per admission, and de novo cardiac arrhythmic events (Table SVI). Although the number of intensive-care unit (ICU) admissions increased (2Á6% during the liberal and 6Á7% during the restrictive transfusion period, P = 0Á05), this was ascribed to a change in practice aiming at ICU transfers at an earlier stage of clinical deterioration.…”

“…Consequently but specifically and solely applying to treatments inducing a limited duration of aplasia, a stricter Hb threshold rather than the switch to single‐unit transfusion episodes seems the main contributor to blood product savings. Notwithstanding, this does not imply a general inefficacy of single‐unit transfusion episodes, as an abundant number of studies performed in varying patient cohorts consistently demonstrated a strong reduction of up to 40% in RBC use after changing to single‐unit transfusion practices 6,8,10,11 …”

Outcome-relevante Anästhesiologie: peri- und postoperative Anämiebehandlung

“…In einer aktuellen Übersichtsarbeit zeigte sich nach Implementierung einer Single Unit Policy in gemischten Patientenkollektiven eine Reduktion des EK-Verbrauchs um bis zu 40% – wobei keine erhöhte Inzidenz kardiovaskulärer Ereignisse beobachtet wurde. Dieselbe Arbeit kam zu dem Ergebnis, dass nur wenige internationale Transfusionsleitlinien diese Maßnahme bisher in ihre Empfehlungen explizit aufgenommen haben 36 . In Ländern wie z.…”