Rational Use of Blood and Blood Components in Hematology and Oncology

Abstract

Objective: In order to minimize bleeding complications, virus transmission, alloimmunization or graft-versus-host disease, a more restrictive transfusion policy may be advantageous. Patients and Methods: In our study we evaluated the transfusion of blood and blood components and the clinical course of 41 patients with hematologic malignancy or solid tumors during hospitalization following transplantation (TX). The threshold for platelets was set at <20,000/μl. Erythrocyte transfusion was found to be indicated at hemoglobin (Hb) values below 8.0 g/dl in hemodynamically/cardiopulmonary unstable patients as severe coagulation disorders implica-ed the replacement of fresh frozen plasma. Leukocyte-reduced, bed-side-filtrated, and radiated (30 Gy) platelets (non-HLA-typed) and red blood cells (RBCs) were transfused. In the case of CMV positivity of the recipient before TX and/or donor, the CMV state of the transfused products was not regarded. Statistical analysis was performed using the χ² assay. Results: Significantly more single-donor concentrates collected by blood separators from Fresenius (AS 104, ASTEC 204) and from Cobe (Spectra LRS) were transfused at group II (allogenic transplantation) patients (17.13 ± 18.59) compared with autologously transplanted (group I) patients (4.77 ± 5.01), whereas no difference could be evaluated in the replacement of RBCs, and fresh frozen plasma. The duration of hospitalization also differed significantly (group I: 36 ± 20 days; group II: 50 ± 23 days). Minor bleedings did occur more or less often in one of each group. No major bleedings were registered. Graft-versus-host diseases could be objected in 8 allogenically transplanted patients. 10/41 patients probably died due to complications associated with the underlying disease and therapy. Conclusion: In view of the socioeconomic interests and being also aware that the potential of blood donors is limited, a more restrictive transfusion policy, if clinically justified, may be indicated even in high-risk patients.