On the quality of transfused packed red blood cell concentrates in Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie-affiliated centres and hospitals

Abstract Background: Supportive care with blood product transfusions is the primary management strategy for the majority of patients with MDS. Approximately 80% of MDS patients are anemic at the time of presentation and more than 40% require regular RBC transfusions at some stage of disease, while platelet transfusions are less often required. Methods: In an effort to systematically study quality of life and economic cost associated with transfusion dependency (especially RBC transfusions), The MDS Foundation has disseminated a practices and treatment survey to its Centers of Excellence and is also accumulating transfusion data. Retrospective and prospective data collected include hematologic parameters defining transfusion need; percentage (%) of MDS patients requiring transfusion; % of transfusion-dependent MDS patients by subtype and International Prognostic Scoring System (IPSS) risk group; per patient frequency of transfusions; % of patients requiring iron chelation therapy. Results: A total of 30 Centers have replied to the survey to date, and responses reveal that a substantial proportion of MDS patients receive multiple RBC transfusions with most of these patients needing chelation therapy with desferoxamine (generally subcutaneous administration, 4-times weekly): Table 1. In addition, detailed data are available from 4 European Centers that have provided transfusion records from randomly selected multiply-transfused MDS patients: 38 patients (median age: 73) received a median of 42 transfusions over the last 24 months (range: 11–207). The average per transfusion costs calculated from estimates provided by the 4 European centers is 436 euros or $ 526 ($1 US dollar = 0.83 euros), where the per transfusion cost includes 2 filtered red blood cell units, blood collection, administrative costs, and staff time, resulting in a median per patient cost over the last 24 months of 11,118 euros (range: 5668–21,800 euros). This does not include the cost of chelation therapy (300 euros/month for desferioxamine SC) and indirect costs (e.g., time spent at transfusion facility, travel time for patient to facility, travel and wait time for private caretaker or family member). Conclusion: Preliminary data analysis from the ongoing retrospective study suggests that the transfusion burden to MDS patients and to society, in terms of quality of life and cost, is much greater than generally appreciated. Updated data of this study will be presented. Table 1: RBC Transfusion-dependent MDS patients Mean % IPSS low risk 39 IPSS intermediate-1 risk 50 IPSS intermediate-2 risk 63 IPSS high risk 79 Iron chelation therapy 28

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Red blood cell transfusion thresholds and Quality of Life in myelodysplastic syndromes: a pilot, feasibility study

http://isrctn.org/> ◽

10.1186/isrctn26088319 ◽

2014 ◽

Author(s):

Gillian Powter

Keyword(s):

Quality Of Life ◽

Blood Cell ◽

Feasibility Study ◽

Red Blood Cell ◽

Myelodysplastic Syndromes ◽

Red Blood Cell Transfusion ◽

Pilot Feasibility Study

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Measuring Health-Related Quality of Life in Sickle Cell Disease Patients Undergoing Automated Red Blood Cell Exchange in the USA, France and the UK

Blood ◽

10.1182/blood-2018-99-109864 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5892-5892

Author(s):

Koenraad Dierick ◽

Joseph Roig

Keyword(s):

Quality Of Life ◽

Sickle Cell Disease ◽

Blood Cell ◽

Red Blood Cell ◽

Blood Cells ◽

Health Related Quality ◽

Cell Disease ◽

Related Quality ◽

Health Related

Abstract Background Sickle cell disease (SCD) is a group of disorders that affects hemoglobin, the molecule in red blood cells that delivers oxygen to cells throughout the body. People with this disorder have atypical hemoglobin molecules called hemoglobin S, which can distort red blood cells into a sickle, or crescent, shape. Additionally, affected red blood cells have a high likelihood of stacking up and causing blockages in the small blood vessels. Both mechanisms of disease may cause damage to organs requiring oxygen, which causes pain and may be deadly. SCD and its complications reduce life expectancy and the nature of its complications and treatments may cause reduced quality of life. Although a rare disease, SCD may cause significant costs to healthcare and society. Depending on the indication, either hydroxyurea or chronic RBC transfusion is employed to treat SCD patients. RBC transfusion, simple or exchange, is first-line treatment for primary and secondary prevention of stroke. When the study was performed, no published research had been completed that compared patient outcomes in terms of Health-Related Quality of Life (HRQoL) for patients treated with automated red blood cell exchange versus simple transfusion. Objectives There are multiple objectives covered within the scope of this study:To quantify HRQoL as experienced by SCD patients in aRBCx versus simple transfusion.To determine the drivers of HRQoL amongst SCD patientsTo assess whether physicians and patients have a similar view on the impact of aRBCx on HRQoL amongst SCD patients. Methodology A cross-sectional study was performed amongst 40 SCD patients, 20 from the USA, 10 from France and 10 from the UK as well as amongst 40 SCD treating physicians with experience in both simple transfusion as well as aRBCX. The physicians had the same regional distribution as the patients. Results SCD patients undergoing aRBCX reported an HRQoL that was 25% higher compared to the period where they were treated with simple transfusion (0.70 vs. 0.55; p<0.01). The main drivers of HRQoL identified were (correlation efficient): pain reduction (0.57), improved social live (0.49), autonomy in terms of all day living activities and being independent from others (0.56), feeling energetic and physical functioning (0.57) and lastly emotional worry and mental health (0.56), all with p-values < 0.01. Together these variables explain 39% of the HRQoL experienced by SCD patients (R² = 0.39, p < 0.01). 80% of the patients preferred aRBCx over simple transfusion. 87% of the participating physicians believed that switching patients from simple transfusion to automated red blood cell exchange (aRBCX) positively affected the SCD patients' quality of life. Physicians identified the following factors being responsible for the improved HRQoL in patients on aRBCX. Those with an average score of 5.5 or greater on a 7-point scale were: less iron overload, RBCX effectiveness, reduced acute complications, reduced chronic complications, and superior mechanism of action during acute situations. Conclusion Sickle cell disease patients that require chronic blood transfusion experience better health-related quality of life when they are treated with automated red blood cell exchange versus simple transfusion. This observation is supported by the opinion of their treating physicians. Disclosures Dierick: Terumo BCT: Employment. Roig:Terumo BCT: Employment.

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Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: protocol for an overview of systematic reviews

BMJ Open ◽

10.1136/bmjopen-2019-029828 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029828 ◽

Cited By ~ 1

Author(s):

Kevin M Trentino ◽

Shannon L Farmer ◽

Frank M Sanfilippo ◽

Michael F Leahy ◽

James Isbister ◽

...

Keyword(s):

Blood Cell ◽

Systematic Reviews ◽

Red Blood Cell ◽

Randomised Controlled Trials ◽

Red Blood Cell Transfusion ◽

Controlled Trials ◽

Overview Of Systematic Reviews ◽

Randomised Controlled ◽

Meta Analyses

IntroductionThere has been a significant increase in the number of systematic reviews and meta-analyses of randomised controlled trials investigating thresholds for red blood cell transfusion. To systematically collate, appraise and synthesise the results of these systematic reviews and meta-analyses, we will conduct an overview of systematic reviews.Methods and analysisThis is a protocol for an overview of systematic reviews. We will search five databases: MEDLINE, Embase, Web of Science Core Collection, PubMed (for prepublication, in process and non-Medline records) and Google Scholar. We will consider systematic reviews and meta-analyses of randomised controlled trials evaluating the effect of haemoglobin thresholds for red blood cell transfusion on mortality. Two authors will independently screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full-text review. We will extract data onto a predefined form designed to summarise the key characteristics of each review. We will assess the methodological quality of included reviews and the quality of evidence in included reviews.Ethics and disseminationFormal ethics approval is not required for this overview as we will only analyse published literature. The findings of this study will be presented at relevant conferences and submitted for peer-review publication. The results are likely to be used by clinicians, policy makers and developers of clinical guidelines and will inform suggestions for future systematic reviews and randomised controlled trials.PROSPERO registration numberCRD42019120503.

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Quality of clinical practice guidelines about red blood cell transfusion

Journal of Evidence-Based Medicine ◽

10.1111/jebm.12330 ◽

2018 ◽

Vol 12 (2) ◽

pp. 113-124 ◽

Cited By ~ 4

Author(s):

Daniel Simancas‐Racines ◽

Nadia Montero‐Oleas ◽

Robin W.M. Vernooij ◽

Ingrid Arevalo‐Rodriguez ◽

Paulina Fuentes ◽

...

Keyword(s):

Clinical Practice ◽

Blood Cell ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Red Blood Cell ◽

Red Blood Cell Transfusion

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Influence of 30 Gy Gamma Irradiation on the Quality of Red Blood Cell Concentrates in Several Storage Media

Transfusion Medicine and Hemotherapy ◽

10.1159/000053491 ◽

1999 ◽

Vol 26 (4) ◽

pp. 212-221 ◽

Cited By ~ 1

Author(s):

H. Bäumler ◽

H. Radtke ◽

T. Haas ◽

R. Latza ◽

H. Kiesewetter

Keyword(s):

Blood Cell ◽

Gamma Irradiation ◽

Red Blood Cell ◽

Storage Media

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Addressing the Quality Gap: An Order Set and Checklist to Improve Red Blood Cell Transfusion Ordering Practices on the Internal Medicine Ward

Blood ◽

10.1182/blood.v124.21.3520.3520 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3520-3520

Author(s):

Eric Tseng ◽

Jordan Spradbrow ◽

Yulia Lin ◽

Jeannie Callum

Keyword(s):

Internal Medicine ◽

Informed Consent ◽

Blood Cell ◽

Red Blood Cell ◽

Transfusion Practice ◽

Single Center ◽

Post Intervention ◽

General Internal ◽

Order Sets

Abstract Background: Recent guidelines, including ASH Choosing Wisely®, recommend the use of restrictive red blood cell (RBC) transfusion strategies. Our aim was to identify gaps in transfusion ordering practices among trainees and staff physicians on the internal medicine inpatient service, by performing an audit to determine compliance with hospital guidelines. This baseline study was then used to develop and implement preprinted orders and a transfusion checklist as an intervention to improve the quality of transfusion practice. Methods: We performed a single-center retrospective audit of all RBC transfusions ordered by trainees and staff physicians for patients admitted to general internal medicine over a 3-month period (June to August 2013). Compliance with institutional guidelines for transfusion indication and dose were ascertained. Secondary measures included documentation of informed consent, ordering of diuretics, and incidence of transfusion-related adverse events. These results guided the development of a checklist, which was implemented alongside evidence-based preprinted order sets in November 2013. The checklist specifically highlighted discussion of life-threatening transfusion risks, documentation of the informed consent process, and indications for pre-transfusion diuretics to prevent transfusion associated circulatory overload. The audit was repeated over a 3-month post-intervention period (November 2013 to January 2014) to assess for improvement. Comparison between the pre- and post-intervention groups was made using the chi-square test and Fisher’s exact test for categorical variables. Results: 90 transfusion orders in 63 patients were audited in the pre-intervention group, compared with 50 transfusion orders in 31 patients post-intervention; total inpatient days declined by 11.5% over the same period. 98.6% of transfusions were ordered by trainees and 1.4% by attending physicians. Baseline compliance for both indication and dose did not change (84.4% pre-intervention vs. 82.0% post-intervention, p = NS), and pre-transfusion hemoglobin was unchanged (69.0 g/L vs. 69.5 g/L). The frequency at which transfusion rate was specified increased after order sets were implemented (83.3% vs. 98.0%, p = 0.01). While the completion of consent forms was unchanged (98.4% vs. 100.0%, p = NS), explicit documentation of a risks and benefits discussion increased significantly (33.3% vs. 61.3%, p = 0.02). The frequency of appropriate diuretic administration increased (36.7% vs. 70.0%, p = 0.01) without increase in acute kidney injury or significant hypokalemia, and the proportion of diuretics ordered pre-transfusion increased (36.4% vs. 90.5%, p < 0.01). No adverse transfusion-related events occurred in either group. Conclusions: In this single-center study, there was good baseline compliance with transfusion guidelines within general internal medicine at our academic center. The development and implementation of preprinted orders and a checklist, based on gaps identified in the documentation of consent and the ordering of diuretics, significantly improved practices in these domains. These data suggest that preprinted orders and targeted checklists may be simple interventions that can be implemented to improve the quality of transfusion practice. Disclosures No relevant conflicts of interest to declare.

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