Clinic of Hematology, University Hospital Zurich, Switzerland.
Haematologica. 2012 Jan;97(1):116-22. doi: 10.3324/haematol.2011.047035. Epub 2011 Sep 20.
Traditionally, single-unit red blood cell transfusions were believed to be insufficient to treat anemia, but recent data suggest that they may lead to a safe reduction of transfusion requirements. We tested this hypothesis by changing from a double- to a single-unit red blood cell transfusion policy.
We performed a retrospective cohort study in patients with hematologic malignancies receiving intensive chemotherapy or hematopoietic stem cell transplantation. The major end-points were the reduction in the total number of red blood cell units per therapy cycle and per day of aplasia. The study comprised 139 patients who received 272 therapy cycles. Overall 2212 red blood cell units were administered in 1548 transfusions.
During the periods of the double- and single-unit policies, one red blood cell unit was transfused in 25% and 84% of the cases and the median number of red blood cell units per transfusion was two and one, respectively. Single-unit transfusion led to a 25% reduction of red blood cell usage per therapy cycle and 24% per aplasia day, but was not associated with a higher out-patient transfusion frequency. In multivariate analysis, single-unit transfusion resulted in a reduction of 2.7 red blood cell units per treatment cycle (P = 0.001). The pre-transfusion hemoglobin levels were lower during the single-unit period (median 61 g/L versus 64 g/L) and more transfusions were administered to patients with hemoglobin values of 60 gl/L or less (47% versus 26%). There was no evidence of more severe bleeding or more platelet transfusions during the single-unit period and the overall survival was similar in both cohorts.
Implementing a single-unit transfusion policy saves 25% of red blood cell units and, thereby, reduces the risks associated with allogeneic blood transfusions.
传统上，人们认为单个单位的红细胞输注不足以治疗贫血，但最近的数据表明，它们可能导致安全的输血需求减少。我们通过从双单位到单单位红细胞输注策略的改变来检验这一假设。
我们对接受强化化疗或造血干细胞移植的血液系统恶性肿瘤患者进行了回顾性队列研究。主要终点是每个治疗周期和无细胞期减少的红细胞单位总数。该研究包括 139 例接受 272 个治疗周期的患者。总共在 1548 次输血中输注了 2212 个红细胞单位。
在双单位和单单位策略期间，分别有 25%和 84%的病例输注了一个红细胞单位，中位数每个输血单位的红细胞单位数分别为两个和一个。单单位输血导致每个治疗周期的红细胞用量减少 25%，无细胞天数减少 24%，但与门诊输血频率增加无关。多变量分析显示，单单位输血导致每个治疗周期的红细胞用量减少 2.7 个单位（P = 0.001）。单单位期间的输血前血红蛋白水平较低（中位数为 61g/L 与 64g/L），更多血红蛋白值为 60g/L 或更低的患者接受了输血（47%与 26%）。在单单位期间没有证据表明更严重的出血或更多的血小板输注，并且两个队列的总生存率相似。
实施单单位输血策略可节省 25%的红细胞单位，从而降低与异体输血相关的风险。
