Single versus double‐unit transfusion: Safety and efficacy for patients with hematologic malignancies. (25th February 2019)

• Record Type: Journal Article
• Authors: Bowman, Zelia; Fei, Naomi; Ahn, Janice; Wen, Sijin; Cumpston, Aaron; Shah, Nilay; Craig, Michael; Perrotta, Peter L.; Kanate, Abraham S.
• Is Part Of: European journal of haematology. Volume 102:Number 5(2019)
• Page Start: 383
• Page End: 388
• Publication Date: 2019-02-25
• Subjects: Blood -- double -- erythrocyte -- hematology -- red blood cell -- single -- transfusion -- unit; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; Blood -- Periodicals; 616.15005
• DOI: 10.1111/ejh.13211
• Languages: English
• ISSNs: 0902-4441

Abstract

Abstract: Objectives: Although hemoglobin thresholds for red blood cell (RBC) transfusion have decreased, double‐unit RBC transfusion practices persist. We studied the effects switching from predominantly double‐unit to single‐unit RBC transfusions had on utilization and clinical outcomes for malignant hematology patients. Methods: Retrospective chart review compared malignant hematology patients before and after implementing single‐unit RBC transfusion policy. Hemoglobin threshold was 8.0 g/dL for both groups. RBC utilization metrics included number of RBC units transfused, RBC units transfused per admission, and number of transfusion episodes. Clinical outcomes included length of stay, 30‐day mortality, and outpatient RBC transfusion 30‐days post‐discharge. Results: Baseline hemoglobin was similar in both groups. The single‐unit group was transfused with fewer RBC units per admission (5.1 vs 4.5, P = 0.01) than the double‐unit group, but had more transfusion episodes per admission (4.1 vs 2.7, P < 0.001). After implementing single‐unit policy, a 29% reduction in RBC utilization was observed. Mean hemoglobin at discharge was lower in the single‐unit group (8.9 vs 9.5 g/dL, P = 0.005). No significant differences in length of stay or 30‐day mortality were observed. Conclusion: Transfusing malignant hematology patients with single RBC units is safe and efficacious. Electronic provider order systems facilitating RBC transfusion requests provide excellent adherence to transfusion policy.