1.
Impact of red blood cell transfusion strategies in haemato-oncological patients: a systematic review and meta-analysis
Hoeks MPA, Kranenburg FJ, Middelburg RA, van Kraaij MGJ, Zwaginga JJ
British Journal of Haematology. 2017;178((1):):137-151
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.
2.
Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial
de Gast-Bakker DH, de Wilde RB, Hazekamp MG, Sojak V, Zwaginga JJ, Wolterbeek R, de Jonge E, Gesink-van der Veer BJ
Intensive Care Medicine. 2013;39((11):):2011-9.
Abstract
OBJECTIVE To investigate the safety and effects of a restrictive red blood cell (RBC) transfusion strategy in pediatric cardiac surgery patients. DESIGN Randomized controlled trial. SETTING Pediatric ICU in an academic tertiary care center, Leiden University Medical Center, Leiden, The Netherlands. PATIENTS One hundred seven patients with non-cyanotic congenital heart defects between 6weeks and 6years of age. One hundred three patients underwent corrective surgery on cardiopulmonary bypass. INTERVENTIONS Prior to surgery patients were randomly assigned to one of two groups with specific RBC transfusion thresholds: Hb 10.8g/dl (6.8mmol/l) and Hb 8.0g/dl (5.0mmol/l). MEASUREMENTS Length of stay in hospital (primary outcome), length of stay in PICU, duration of ventilation (secondary outcome), incidence of adverse events and complications related to randomization (intention to treat analysis). RESULTS In the restrictive transfusion group, mean volume of transfused RBC was 186 (+/-70) ml per patient and in the liberal transfusion group 258 (+/-87) ml per patient, (95% CI 40.6-104.6), p<0.001. Length of hospital stay was shorter in patients with a restrictive RBC transfusion strategy: median 8 (IQR 7-11) vs. 9 (IQR 7-14) days, p=0.047. All other outcome measures and incidence of adverse effects were equal in both RBC transfusion groups. Cost of blood products for the liberal transfusion group was 438.35 (+/-203.39) vs. 316.27 (+/-189.96) euros (95% CI 46.61-197.51) per patient in the restrictive transfusion group, p=0.002. CONCLUSIONS For patients with a non-cyanotic congenital heart defect undergoing elective cardiac surgery, a restrictive RBC transfusion policy (threshold of Hb 8.0g/dl) during the entire perioperative period is safe, leads to a shorter hospital stay and is less expensive.