Gupta P, LeRoy S C, Luikart S D, Bateman A, Morrison V A
Hematology/Oncology Section 111E, Veterans Administration Medical Center, Minneapolis, MN 55417, USA.
Leuk Res. 1999 Oct;23(10):953-9. doi: 10.1016/s0145-2126(99)00113-7.
Patients with myelodysplastic syndromes (MDS) frequently become dependent on blood transfusions. We analyzed the total transfusion support required, and its complications and cost, following the diagnosis of MDS (total period = 79.7 patient-years) in 50 patients followed at the Minneapolis VA Medical Center. From diagnosis of MDS to transformation to AML or death (the MDS phase), 41 patients (82%) required transfusions. The median numbers of transfused blood products per patient per year of follow-up in the MDS phase were: packed red blood cells (pRBC), 11.1 (range, 0-91.3) units, random donor platelets (RDP), 6.8 (range, 0-581) units, and single donor apheresis platelet packs (SDP): 0 (range, 0-40) collections. In the AML phase (time from diagnosis of secondary AML to death or last follow-up), median transfusion requirements per patient (n = 5) were 24 (range, 8-88) units pRBC, 94 (range, 24-480) units RDP and 3 (range, 0-19) collections of SDP. Overall, 80% of patients required either special processing or selection of blood products, had reactions to blood products or required premedications (specified/complicated transfusions); 94% of all pRBC and 97% of all platelet transfusions were specified/complicated. The median cost of transfusions per patient was $4048 (range, $0-73210) during the MDS phase and $13210 (range, $5288-59010) during the AML phase. During the MDS phase, the median cost was $4877 (range, $0-67050) per patient-year of follow-up; the major proportion of this cost was for pRBC transfusions. Long-term support with frequent transfusions for MDS usually requires specially selected or processed blood products, and is associated with a high incidence of transfusion reactions. This study provides baseline data on the costs of transfusion support for MDS, and can be used for comparing resource utilization and costs of long-term transfusion support (supportive care) with growth factor therapy or disease-modifying modalities such as allogeneic transplantation.
骨髓增生异常综合征（MDS）患者常依赖输血治疗。我们分析了明尼阿波利斯退伍军人事务医疗中心随访的50例MDS患者确诊后所需的总输血支持及其并发症和费用（总观察期为79.7患者年）。从MDS诊断至转化为急性髓系白血病（AML）或死亡（MDS阶段），41例患者（82%）需要输血。在MDS阶段，每位患者每年随访期间输注血液制品的中位数为：浓缩红细胞（pRBC）11.1单位（范围0 - 91.3单位），随机供者血小板（RDP）6.8单位（范围0 - 581单位），单采血小板（SDP）：0次采集（范围0 - 40次采集）。在AML阶段（从继发性AML诊断至死亡或最后随访的时间），每位患者（n = 5）的输血需求中位数为pRBC 24单位（范围8 - 88单位），RDP 94单位（范围24 - 480单位），SDP 3次采集（范围0 - 19次采集）。总体而言，80%的患者需要对血液制品进行特殊处理或选择、出现血液制品反应或需要预防性用药（特定/复杂输血）；所有pRBC输注的94%和所有血小板输注的97%为特定/复杂输血。在MDS阶段，每位患者输血的中位数费用为4048美元（范围0 - 73210美元），在AML阶段为13210美元（范围5288 - 59010美元）。在MDS阶段，每位患者每年随访的中位数费用为4877美元（范围0 - 6705
