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Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States
Author(s) -
Pine Alexander B.,
Lee EunJu,
Sekeres Mikkael,
Steensma David P.,
Zelterman Daniel,
Prebet Thomas,
DeZern Amy,
Komrokji Rami,
Litzow Mark,
Luger Selina,
Stone Richard,
Erba Harry P.,
GarciaManero Guillermo,
Lee Alfred I.,
Podoltsev Nikolai A.,
Barbarotta Lisa,
Kasberg Stephanie,
Hendrickson Jeanne E.,
Gore Steven D.,
Zeidan Amer M.
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13934
Subject(s) - medicine , blood product , cryoprecipitate , intensive care medicine , blood transfusion , blood management , platelet transfusion , ambulatory , emergency medicine , fibrinogen , surgery , platelet
BACKGROUND Transfusion of blood products is a key component of the supportive management in patients with acute leukemia (AL). However high‐quality trial evidence and clinical outcome data to support specific transfusion goals for blood products for patients with AL remain limited leading to diverse transfusion practices. The primary objective of this study was to determine the spectrum of transfusion patterns in a variety of care settings among providers who treat AL patients. STUDY DESIGN AND METHODS A 31‐question survey queried providers caring for AL patients about the existence of institutional guidelines for transfusion of blood products, transfusion triggers for hemoglobin (Hb), platelets (PLTs), and fibrinogen in various settings including inpatient and outpatient and before procedures. RESULTS We analyzed 130 responses and identified divergent transfusion Hb goals in hospitalized and ambulatory patients, fibrinogen goals for cryoprecipitate transfusions, and variation in practice for use of certain PLTs and red blood cell products. The least variable transfusion patterns were reported for PLT goals in thrombocytopenia and in the setting of invasive procedures such as bone marrow biopsy and lumbar punctures. CONCLUSIONS This survey confirmed wide variations in blood product transfusion practices across several clinical scenarios in patients with AL. The findings emphasized the need for large prospective randomized trials to develop standardized evidence‐based guidelines for blood product transfusions in patients with AL with the goal of limiting unnecessary transfusions without compromising outcomes.