Transfusion strategies in hematologic and nonhematologic disease

Carson, Jeffrey L.; Strair, Roger

doi:10.1182/asheducation-2014.1.548

Cited by 14 publications

(7 citation statements)

References 27 publications

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“…[36][37][38] Also, there is an association between postoperative anemia and receiving blood transfusion, 39 and patients with hematologic diseases may be transfused more liberally. 40 Patients with non-Hodgkin's lymphoma and myeloproliferative neoplasms were at an increased risk of hematoma/seroma development, which is in accordance with other studies. [41][42][43] Patients with leukemia and myeloproliferative neoplasms had a greater risk for pulmonary embolism and DVT, respectively.…”

Section: Discussionsupporting

confidence: 91%

Hematologic Malignancies Are Associated with Adverse Perioperative Outcomes following Total Knee Arthroplasty

et al. 2017

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The treatment of hematologic malignancies has advanced over the years, resulting in an improved survival of patients. As a result, these patients may be a part of the increasing population requiring total knee arthroplasty (TKA); however, they might be at a higher risk of adverse perioperative outcomes. The purpose of this study was to determine the perioperative outcomes (complications, length of stay [LOS], and costs) of patients with hematologic malignancies following TKA. This study used the Nationwide Inpatient Sample (NIS) to identify patients who underwent TKA in the United States from 2000 to 2011. Patients diagnosed with any hematologic malignancy ( = 24,714) were then stratified by Hodgkin's disease ( = 791), Non-Hodgkin's lymphoma ( = 7,096), plasma cell dyscrasias ( = 1,621), leukemia ( = 8,005), myeloproliferative disease ( = 5,746), and/or myelodysplastic syndromes ( = 1,608) for determining the complications that occurred during admission. Propensity matching was performed for demographics, hospital characteristics, and comorbidities, which yielded 24,491 patients with any hematologic malignancy and 24,458 control patients. Additionally, propensity matching was performed for the hematologic malignancy subtypes. Multivariable regression models were used to analyze the surgical and medical complications, LOS, and costs. The annual frequency of THA in patients with any hematologic malignancy increased from 2000 to 2011 ( < 0.0001). Hematologic malignancies were associated with an increased risk of any surgery-related complication (odds ratio [OR] = 1.31, < 0.0001) and any general medical complication (OR = 1.38, < 0.0001). Patients with any hematologic malignancy had increased odds of complications, including acute postoperative anemia (OR = 1.29, < 0.0001), hematoma/seroma (OR = 1.65, < 0.02), peripheral vascular disease (OR = 2.23, = 0.046), deep venous thrombosis (DVT) (OR = 1.95, = 0.02), and blood transfusion (OR = 1.61, < 0.0001). Hematologic malignancies were associated with an increased incremental LOS (0.13 d, < 0.0001) and an increased incremental cost ($788, < 0.0001). Thus, we conclude that following TKA, patients with hematologic malignancies are at an increased risk of perioperative complications, longer LOS, and higher costs. The risk quantification for adverse perioperative outcomes in association with an increased cost may help design different risk stratification and reimbursement methods in such patients when undergoing TKA.

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Section: Discussionsupporting

confidence: 91%

Hematologic Malignancies Are Associated with Adverse Perioperative Outcomes following Total Knee Arthroplasty

et al. 2017

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“…There is thus a lack of evidence for transfusion as an effective treatment to protect against the deleterious effects of pre‐operative anaemia. This should be taken in combination with the dose‐dependent relationship between transfusion and complications (Ferraris et al , ), with systematic reviews showing liberal transfusion to be either inferior (Carson et al , ; Rohde et al , ) or non‐beneficial (Carson & Strair, ; Holst et al , ) compared to restrictive strategies, and evidence of both short‐term (Bolton‐Maggs et al , ) and longer‐term (Amato & Pescatori, ) risks of transfusion. Elective transfusion to normal or near‐normal Hb in anticipation of operative blood loss is therefore not recommended; particularly as evidence‐based anaemia treatments are available.…”

Section: Management Optionsmentioning

confidence: 99%

British Committee for Standards in Haematology Guidelines on the Identification and Management of Pre‐Operative Anaemia

et al. 2015

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“…Our findings are in concordance with outcomes from non-oncologic studies that have investigated the role of liberal and restrictive transfusion strategies and found restrictive transfusion strategies (defined by use of a hemoglobin trigger of 7–8 g/dL) safe and effective. [42, 43] The Transfusion Requirement in Critical Care (TRICC) trial is a landmark study that was one of the first trials to challenge the view that a hemoglobin threshold of 10 g/dL should be standard of care. [18] The TRICC trial revealed a non-significant trend towards decreased mortality in the restrictive group among critically ill patients admitted to the ICU (18.7% v. 23.3%, P = 0.1).…”

Section: Discussionmentioning

confidence: 99%

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

Prescott

Taylor

López-Olivo

et al. 2016

Cancer Treatment Reviews

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Background Most non-oncologic clinical practice guidelines recommend restrictive allogeneic blood transfusion practices; however, there is a lack of consensus regarding the best transfusion practice in oncology. We conducted a systematic review of the literature to compare the efficacy and safety of restrictive versus liberal transfusion strategies in patients with cancer. Methods A literature search using MEDLINE, PUBMED and EMBASE identified all controlled studies comparing the use of restrictive with liberal transfusion in adult oncology participants up to August 10, 2015. Two review authors independently assessed studies for inclusion, extracted data and appraised the quality of the included studies. The primary outcomes of interest were blood utilization and all-cause mortality. Results Out of 4241 citations, six studies (3 randomized and 3 non-randomized) involving a total of 983 patients were included in the final review. The clinical context of the studies varied with 3 chemotherapy and 3 surgical studies. The overall risk of bias in all studies was moderate to high. Restrictive transfusion strategies were associated with a 36% reduced risk of receiving a perioperative transfusion (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.49 to 0.83). There was no difference in mortality between the strategies (RR 1.00, 95% CI 0.32 to 3.18). There were no differences in adverse events reported between the restrictive and liberal transfusion strategies. Conclusion Restrictive strategy appears to decrease blood utilization without increasing morbidity or mortality in oncology. This review is limited by a paucity of high quality studies on this topic. Better designed studies are warranted.

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Transfusion strategies in hematologic and nonhematologic disease

Cited by 14 publications

References 27 publications

Hematologic Malignancies Are Associated with Adverse Perioperative Outcomes following Total Knee Arthroplasty

Hematologic Malignancies Are Associated with Adverse Perioperative Outcomes following Total Knee Arthroplasty

British Committee for Standards in Haematology Guidelines on the Identification and Management of Pre‐Operative Anaemia

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

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