The use of a blood conservation device to reduce red blood cell transfusion requirements: a before and after study

16002 Background: Epoetin alfa (EPO) and darbepoetin alfa (DARB) are used to treat cancer-related anemia and to reduce the requirements for blood transfusions. To date, limited information on the relative effectiveness of these agents in the inpatient setting is available. This analysis evaluated red blood cell (RBC) transfusion rates in cancer patients receiving EPO or DARB during hospitalization. Methods: An analysis of electronic inpatient hospital records from the Premier Perspective Comparative Hospital Database was conducted to compare RBC transfusion rates in cancer patients receiving EPO or DARB therapy. Study subjects were identified through hospitalizations recorded between 07/2002 and 03/2005 from over 500 hospitals nationwide. Patients were required to be ≥18 years old, have a primary admitting diagnosis of cancer and be treated with EPO or DARB during hospitalization. Patients who had received renal dialysis were excluded. To minimize effects of outliers, 5% of patients with extreme doses in each group were excluded from the dosing analysis. In addition to descriptive statistics on transfusion requirements, a multivariate logistic model was employed to isolate the effect of an individual erythropoietic agent on the risk of RBC transfusion after controlling for patient demographics, comorbidities, admission characteristics, use of IV or oral iron and hospitalization severity markers. Results: Among the 24,814 EPO and 2,990 DARB study patients, mean age and gender distribution at admission were similar (age: EPO 65.3 years, DARB 64.5 years; %women: EPO 53%, DARB 55%). Mean cumulative dose per inpatient stay was EPO 61,656 ± 50,274 Units and DARB 259 ± 340 mcg. RBC transfusions occurred in 37.9% of EPO patients compared to 39.8% of DARB patients (p=0.0404). Transfused EPO patients received a mean of 2.24 units versus 2.20 units for DARB patients (p=0.2111). After adjusting for covariates, the multivariate model confirmed that DARB treatment was associated with a higher risk of transfusion compared to EPO (odds ratio: 1.2, 95% CI: 1.1–1.3, p=0.0007). Conclusions: This analysis of inpatients with cancer indicates DARB treatment is associated with a higher risk of receiving RBC transfusion compared to treatment with EPO. [Table: see text]

Download Full-text

Packed red blood cell transfusion practices in cardiothoracic surgery before and after the implementation of transfusion clinical decision support

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.07.799 ◽

2014 ◽

Vol 219 (4) ◽

pp. e153-e154

Author(s):

Seyed Amirhossein Razavi ◽

Alexis B. Carter ◽

John D. Puskas ◽

Sara R. Gregg ◽

Iman F. Aziz ◽

...

Keyword(s):

Decision Support ◽

Blood Cell ◽

Clinical Decision Support ◽

Red Blood Cell ◽

Clinical Decision ◽

Cardiothoracic Surgery ◽

Red Blood Cell Transfusion ◽

Before And After

Download Full-text

Implementation of a transfusion bundle reduces inappropriate red blood cell transfusions in intensive care - a before and after study

Transfusion Medicine ◽

10.1111/tme.12364 ◽

2016 ◽

Vol 26 (6) ◽

pp. 432-439 ◽

Cited By ~ 7

Author(s):

M. Borgert ◽

J. Binnekade ◽

F. Paulus ◽

M. Vroom ◽

A. Vlaar ◽

...

Keyword(s):

Intensive Care ◽

Blood Cell ◽

Red Blood Cell ◽

Before And After ◽

Red Blood Cell Transfusions ◽

Before And After Study

Download Full-text

Maintenance treatment of patients with myelodysplastic syndromes using recombinant human granulocyte colony-stimulating factor

Blood ◽

10.1182/blood.v76.1.36.bloodjournal76136 ◽

1990 ◽

Vol 76 (1) ◽

pp. 36-43 ◽

Cited By ~ 3

Author(s):

RS Negrin ◽

DH Haeuber ◽

A Nagler ◽

Y Kobayashi ◽

J Sklar ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Myelodysplastic Syndromes ◽

Red Blood Cell Transfusion ◽

Granulocyte Colony Stimulating Factor ◽

Risk Of Infection ◽

Colony Stimulating Factor ◽

Transfusion Requirements ◽

Increased Risk ◽

Stimulating Factor

Myelodysplastic syndromes (MDS) are characterized by chronic refractory cytopenias resulting in increased risk of infection, bleeding, and conversion to acute leukemia. In an effort to improve these cytopenias we have treated 18 patients over a 6- to 8-week period with increasing daily subcutaneous doses of recombinant human granulocyte colony- stimulating factor (G-CSF). Sixteen patients responded with improvement in neutrophil counts. On cessation of treatment these counts returned to baseline values over a 2- to 4-week period. To maintain these improved blood counts 11 patients were treated with G-CSF for more prolonged periods. Ten patients again responded with an increase in total leukocyte counts (1.6- to 6.4-fold) and absolute neutrophil counts (ANC) (3.6- to 16.3-fold), with responses persisting for 3 to 16 months. A significantly decreased risk of developing bacterial infections was noted during periods with ANC greater than 1,500/mm3 as compared with periods of time with ANC less than 1,500/mm3. Two anemic patients had a greater than 20% rise in hematocrit over the study period, and 2 additional patients had a decrease in red blood cell transfusion requirements during G-CSF treatment. Bone marrow myeloid maturation improved in 7 of 9 maintenance phase patients. Three patients progressed to acute myeloid leukemia during treatment. The drug was generally well-tolerated and no severe toxicities were noted. These data demonstrated that G-CSF administered to MDS patients by daily subcutaneous administration was well-tolerated and effective in causing persistent improvement of the neutrophil levels and marrow myeloid maturation. These effects were associated with a decreased risk of infection and, in some patients, with decreased red blood cell transfusion requirements.

Download Full-text

Comparison of the effects of aprotinin and tranexamic acid on blood loss and red blood cell transfusion requirements during the late stages of liver transplantation

Transfusion ◽

10.1111/j.1537-2995.2006.00770.x ◽

2006 ◽

Vol 46 (4) ◽

pp. 595-605 ◽

Cited By ~ 43

Author(s):

Brigitte E. Ickx ◽

Philippe J. van der Linden ◽

Christian Melot ◽

Walter Wijns ◽

Luc de Pauw ◽

...

Keyword(s):

Liver Transplantation ◽

Blood Loss ◽

Blood Cell ◽

Tranexamic Acid ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Transfusion Requirements ◽

Late Stages

Download Full-text

Use of recombinant human erythropoietin in allogeneic bone marrow transplant donor/recipient pairs

Blood ◽

10.1182/blood.v83.7.1952.1952 ◽

1994 ◽

Vol 83 (7) ◽

pp. 1952-1957 ◽

Cited By ~ 18

Author(s):

AJ Mitus ◽

JH Antin ◽

CJ Rutherford ◽

CJ McGarigle ◽

MA Goldberg

Keyword(s):

Bone Marrow ◽

Blood Cell ◽

Red Blood Cell ◽

Recombinant Human Erythropoietin ◽

Allogeneic Bone Marrow Transplantation ◽

Allogeneic Bone Marrow ◽

Red Blood Cell Transfusion ◽

Allogeneic Bone ◽

Human Erythropoietin ◽

Transfusion Requirements

Abstract In an attempt to reduce or eliminate homologous red blood cell transfusion requirements during allogeneic bone marrow transplantation (BMT), we instituted a novel program whereby recombinant human erythropoietin was administered to pairs of BMT donors and recipients. Eleven recipients and their HLA-matched donors were enrolled. Donors treated with recombinant human erythropoietin (rHuEPO) were phlebotomized a median of 6 U (range, 4 to 11 U) of blood over a 5-week period. This donor-derived blood was available to the BMT donor or recipient as needed. Transplant recipients were also treated with rHuEPO post-BMT to hasten erythropoiesis. Five of 11 BMT recipients underwent transplant receiving only donor-derived red blood cell transfusion, compared with 0 of 11 concomitant control recipients (P = .04). In addition, the time to absolute reticulocyte count > or = 10(4)/microL was statistically shorter in the rHuEPO-treated recipient group. This study serves as a paradigm for hematopoietic growth factor use in allogeneic BMT to decrease or eliminate homologous transfusion exposures and to possibly hasten hematopoietic engraftment.

Download Full-text