Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Hematology, Landspitali National University Hospital of Iceland, Reykjavik, Iceland.
Vox Sang. 2019 Jul;114(5):495-504. doi: 10.1111/vox.12775. Epub 2019 Mar 29.
Revised Icelandic guidelines proposed a restrictive haemoglobin (Hb) threshold of 70 g/l for red blood cell (RBC) transfusions in general, but 100 g/l for malignancies/bone marrow suppression. Chronic lymphocytic leukaemia (CLL) is frequently complicated by anaemia. The objective was to investigate RBC transfusion practices in CLL.
This retrospective nation-wide study utilized an Icelandic registry of CLL patients diagnosed between 2003 and 2016. Medical records were reviewed and haemoglobin transfusion triggers compared for two periods: Earlier (2003-2012) and latter (2013-2017).
Two hundred and thirteen patients were diagnosed with CLL over the period whereof 77 (36·2%) received RBC transfusion(s). Median time from diagnosis to first transfusion was 2·2 years. Higher age, Rai stage 3/4 at diagnosis (P < 0·05) and chemotherapy (P < 0·001) were associated with increased odds of transfusions. Shorter time to first transfusion correlated with higher age (P < 0·001) and Rai stage (P = 0·02) at diagnosis. The mean Hb trigger was 90·4 and 81·2 in the earlier and latter period respectively (P = 0·01). This difference in Hb triggers was most pronounced in patients without documented bone marrow involvement, or 80·5 g/l compared to 93·5 g/l (P = 0·004). The median time from diagnosis to transfusion was longer in the latter period (2·9 years vs. 1·6 years, P = 0·01). After RBC transfusions the survival decreased significantly (P < 0·001).
One-third of CLL patients received RBC transfusions but few were heavily transfused. Older age, Rai stage, and chemotherapy predicted RBC use. The Hb transfusion trigger decreased over time while time to first RBC transfusion increased. RBC transfusions predict poor survival.
修订后的冰岛指南建议将一般情况下红细胞（RBC）输注的血红蛋白（Hb）阈值限制在 70g/l，但恶性肿瘤/骨髓抑制时为 100g/l。慢性淋巴细胞白血病（CLL）常伴有贫血。本研究旨在调查 CLL 患者的 RBC 输注情况。
本回顾性全国性研究利用了冰岛 2003 年至 2016 年间诊断的 CLL 患者的登记处。对病历进行了回顾，并比较了两个时期的血红蛋白输注触发因素：早期（2003-2012 年）和晚期（2013-2017 年）。
在此期间，共有 213 例患者被诊断为 CLL，其中 77 例（36.2%）接受了 RBC 输注。从诊断到首次输血的中位时间为 2.2 年。更高的年龄、诊断时的 Rai 分期 3/4（P<0.05）和化疗（P<0.001）与输血的可能性增加相关。首次输血的时间越短，与诊断时的年龄（P<0.001）和 Rai 分期（P=0.02）呈正相关。早期和晚期的平均 Hb 触发值分别为 90.4 和 81.2（P=0.01）。在没有骨髓受累记录或 80.5g/l 的患者中，Hb 触发值的差异最为明显，而在 93.5g/l 的患者中差异不明显（P=0.004）。晚期的中位输血时间较长（2.9 年比 1.6 年，P=0.01）。接受 RBC 输血后，生存显著下降（P<0.001）。
三分之一的 CLL 患者接受了 RBC 输血，但很少有患者需要大量输血。年龄较大、Rai 分期和化疗预测 RBC 的使用。随着时间的推移，Hb 输血阈值下降，而首次 RBC 输血的时间增加。RBC 输血预示着预后不良。
