Red blood cell utilization and transfusion triggers in patients diagnosed with chronic lymphocytic leukaemia in Iceland 2003–2016

Abstract

Revised Icelandic guidelines proposed a restrictive haemoglobin (Hb) threshold of 70g/l for red blood cell (RBC) transfusions in general, but 100g/l for malignancies/bone marrow suppression. Chronic lymphocytic leukaemia (CLL) is frequently complicated by anaemia. The objective was to investigate RBC transfusion practices in CLL. This retrospective nation-wide study utilized an Icelandic registry of CLL patients diagnosed between 2003 and 2016. Medical records were reviewed and haemoglobin transfusion triggers compared for two periods: Earlier (2003-2012) and latter (2013-2017). Two hundred and thirteen patients were diagnosed with CLL over the period whereof 77 (36·2%) received RBC transfusion(s). Median time from diagnosis to first transfusion was 2·2years. Higher age, Rai stage 3/4 at diagnosis (P<0·05) and chemotherapy (P<0·001) were associated with increased odds of transfusions. Shorter time to first transfusion correlated with higher age (P<0·001) and Rai stage (P=0·02) at diagnosis. The mean Hb trigger was 90·4 and 81·2 in the earlier and latter period respectively (P=0·01). This difference in Hb triggers was most pronounced in patients without documented bone marrow involvement, or 80·5g/l compared to 93·5g/l (P=0·004). The median time from diagnosis to transfusion was longer in the latter period (2·9years vs. 1·6years, P=0·01). After RBC transfusions the survival decreased significantly (P<0·001). One-third of CLL patients received RBC transfusions but few were heavily transfused. Older age, Rai stage, and chemotherapy predicted RBC use. The Hb transfusion trigger decreased over time while time to first RBC transfusion increased. RBC transfusions predict poor survival.