Department of Medicine, Division of General Internal Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Medicine, Division of Hematology, Queen's University, Kingston, Ontario, Canada.
Transfusion. 2019 Jul;59(7):2308-2315. doi: 10.1111/trf.15335. Epub 2019 May 6.
Transfusion of 2 units of red blood cells (RBCs) for Hb ≤80 g/L is the prevailing liberal practice for patients undergoing intensive treatment for acute leukemia or hematopoietic transplant across North America. There is little evidence regarding optimal transfusion targets in these highly transfusion-dependent patient populations.
This was a retrospective pre-post cohort study of consecutive patients admitted to Kingston Health Sciences Center between April through December 2016 (pre) and April through December 2017 (post) for acute leukemia induction chemotherapy or high dose chemotherapy (HDCT) for autologous stem cell transplantation (ASCT). The pre-cohort was transfused using a liberal threshold (2 units of RBCs for Hb ≤80 g/L) and the post-cohort using a more restrictive threshold (1 unit RBCs for Hb ≤70 g/L), implemented with a computerized physician order entry form. Primary outcome was number of RBC units transfused per inpatient day. Secondary outcomes included inpatient mortality and select morbidity measures.
124 patients underwent 134 treatment courses: 62 courses of induction chemotherapy (pre = 26, post = 36) and 72 courses of HDCT for ASCT (pre = 39, post = 33). There was a significant decrease in median RBC utilization per admission in both patient populations: 10.5 versus 6.7 in the leukemia group (p = 0.01) and 2.0 versus 1.0 in the ASCT group (p = 0.04). This reduction was seen without a difference in inpatient mortality, length of stay, falls, serious bleeds, requirement for ICU, or time to engraftment post ASCT.
A restrictive transfusion strategy in patients receiving intensive chemotherapy for acute leukemia or ASCT decreased inpatient RBC usage without increasing adverse inpatient events.
在北美，接受强化治疗的急性白血病或造血移植患者，当血红蛋白（Hb）≤80g/L 时，输注 2 单位红细胞（RBC）是普遍的宽松治疗方案。对于这些高度依赖输血的患者人群，关于最佳输血目标的证据很少。
这是一项回顾性的前后队列研究，纳入了 2016 年 4 月至 12 月（前）和 2017 年 4 月至 12 月（后）期间因急性白血病诱导化疗或自体干细胞移植（ASCT）的高剂量化疗（HDCT）而入住金士顿健康科学中心的连续患者。在前一队列中，使用宽松的阈值（Hb≤80g/L 时输注 2 单位 RBC）进行输血，在后一队列中，使用更严格的阈值（Hb≤70g/L 时输注 1 单位 RBC）进行输血，该阈值通过计算机化的医生医嘱输入表单来实施。主要结局是每住院日输注 RBC 单位数。次要结局包括住院死亡率和选定的发病率指标。
共有 124 名患者接受了 134 个治疗疗程：62 个诱导化疗疗程（前=26，后=36）和 72 个 ASCT 的 HDCT 疗程（前=39，后=33）。两个患者群体的中位 RBC 使用率均显著下降：白血病组为 10.5 单位/住院日 vs. 6.7 单位/住院日（p=0.01），ASCT 组为 2.0 单位/住院日 vs. 1.0 单位/住院日（p=0.04）。在没有增加住院期间死亡率、住院时间、跌倒、严重出血、需要 ICU、或 ASCT 后植入时间的情况下，观察到这种减少。
在接受强化化疗治疗急性白血病或 ASCT 的患者中，采用限制性输血策略可减少住院 RBC 用量，而不会增加不良住院事件。
