Comparing the ratio of mean red blood cell transfusion episode rate of 1 unit versus 2 units in hematopoietic stem cell transplant patients.

Abstract

Two units of red blood cells (RBCs) were typically transfused with each transfusion among hematopoietic stem cell transplant (HSCT) patients. Concerns regarding this practice are increased morbidity, mortality, hospital-acquired infections, length of stay (LOS), and transfusion-related complications. This study compared outcomes of transfusing 1unit of RBCs per transfusion episode to 2units of RBCs per episode among HSCT patients. A retrospective record review was used to evaluate a practice change of transfusing 1 RBC unit per episode among autologous and allogeneic HSCT patients. Primary endpoints included: 1) mean number of RBC transfusion episodes during the hospital stay, 2) mean number of RBC units transfused adjusted by LOS, and 3) mean LOS. Among autologous patients, the ratio of mean rate of transfusion episodes for transfusing 1unit versus 2units per transfusion was 1.24, with a one-tailed 95% upper limit of 1.42. With a noninferiority upper bound of 1.50, using 1unit per transfusion episode was noninferior to 2units per transfusion episode (p=0.011). Among allogeneic HSCT patients, the ratio of mean transfusion episode rate was 1.26 with a one-tailed 95% upper limit of 1.52, which was slightly above the 1.50 noninferiority bound (p=0.061). A single-unit transfusion policy was not inferior to the 2-unit policy for autologous HSCT patients and trended toward noninferiority for allogeneic transplant patients. The mean volume of blood per LOS was lower for the 1-unit practice for both groups. The gains from the practice change may outweigh the risks of not changing.