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Impact of red blood cell transfusion strategies in haemato-oncological patients: a systematic review and meta-analysis

Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands. Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands. Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands. Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands. Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, the Netherlands. Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands. Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands. Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands. Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands. Unit Donor Affairs, Sanquin Blood Bank, Amsterdam, the Netherlands. Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands. Department of Immuno-haematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands.

British Journal of Haematology. 2017;178((1):):137-151
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Abstract
Haemato-oncological patients receive many red blood cell (RBC) transfusions, however evidence-based guidelines are lacking. Our aim is to quantify the effect of restrictive and liberal RBC transfusion strategies on clinical outcomes and blood use in haemato-oncological patients. A literature search, last updated on 11 August 2016, was performed in PubMed, EMBASE (Excerpta Medica Database), Web of Science, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Academic Search Premier without restrictions on language and year of publication. Randomized controlled trials and observational studies that compared different RBC transfusion strategies in haemato-oncological patients were eligible for inclusion. Risk of bias assessment according to the Cochrane collaboration's tool and Newcastle-Ottawa scale was performed. After removing duplicates, 1142 publications were identified. Eventually, 15 studies were included, reporting on 2636 patients. The pooled relative risk for mortality was 0.68 [95% confidence interval (CI) 0.46-1.01] in favour of the restrictive strategy. The mean RBC use was reduced with 1.40 units (95% CI 0.70-2.09) per transfused patient per therapy cycle in the restrictive strategy group. There were no differences in safety outcomes. All currently available evidence suggests that restrictive strategies do not have a negative impact regarding clinical outcomes in haemato-oncological patients, while it reduces RBC use and associated costs.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine