Home Transfusion Research Articles

Perceptions of a Home Blood Transfusion Program Among Patients with Hematologic Malignancies Who Are Newly Diagnosed As Compared to Those with Relapsed/Refractory Disease

Background: In the United States, home-based blood transfusion programs are not standard of care for patients with transfusion dependent cytopenias, despite the significant burden for patients needing to regularly travel to receive transfusions. While prior research regarding potential benefits of home-based transfusions has focused on patients near the end of life, home-based transfusion services have the potential to reduce patient and caregiver burden for patients with transfusion-dependent hematologic malignancies (HM) across the spectrum of disease. It is imperative to understand the utility of home services in patients at any point in the treatment process. The aim of this study is to compare experiences with hospital-based blood transfusion programs and perceptions of a potential home blood transfusion program in patients with HMs on their first line of treatment versus those who have received 2 or more lines of therapy. Methods:We performed semi-structured interviews with patients with transfusion-dependent HM at Thomas Jefferson University Hospital. Patients were split into two groups; those on first line treatment and those who have received 2 or more lines of treatment. Interviews were transcribed, coded, and analyzed using a content analysis approach. The entire team developed the codebook and coding was conducted by two team members. Coding was monitored with frequent assessments to ensure interrater reliability across codes. Results:We interviewed 20 patients: 11 patients had acute leukemia (55%) and 9 had myelodysplastic syndrome (45%). The median age was 56 (Range: 23-85). 11 (55%) patients identified as female, 12 (60%) as Caucasian, and 5 (25%) as Black/African American. Twelve (60%) patients were on 1 st line treatment and 8 (40%) patients were on 2 nd or 3 rd line treatment at the time of the interview. Patients in both groups felt that familiarity of the care team would be essential for a home transfusion service. This stemmed from concerns of lack of comfort and inconsistency in care experienced with current home care services. Several patients on 2+ lines of therapy felt that individuals with relapsed/refractory disease or those who are physically incapable of going to in-person appointments would benefit the most from home transfusions. Otherwise, patients across both groups had similar concerns about home services, including scheduling issues, a sufficient home environment, and management of complications in the home. Despite such concerns, overall patients in both groups viewed a home blood transfusion program favorably. Most patients agreed that home services would ease inconveniences of transportation and travel time/costs of in-person appointments. Patients also perceived a benefit of increased comfort with home transfusions. Conclusions: Regardless of their stage of treatment, HM patients who depend on transfusions demonstrated comparable levels of openness towards home transfusion services. They also perceived similar benefits and concerns associated with receiving transfusion services at home. The majority of patients perceived increased comfort, convenience, and quality of life with home services, supporting the potential benefit of home transfusion services for transfusion dependent patients across the treatment course and not just at end of life.

P‐TS‐36 | Home Transfusion: A 4‐Year Post‐Pandemic Experience at a Tertiary Care Hospital in Spain

P‐TS‐36 | Home Transfusion: A 4‐Year Post‐Pandemic Experience at a Tertiary Care Hospital in Spain

Home transfusions are implemented using diverse approaches in Japan.

Japan's ageing society has increased the need for home healthcare, including home transfusions. We hence aimed to elucidate the purpose and utilization of home transfusions in Japan, which has not been clarified to date. Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The study period was February to December 2019, and information of patients receiving home red blood cell transfusions, including patient background, pre-transfusion laboratory data and the purpose of the transfusions, was collected. Haematological malignancies and solid tumours accounted for 70% of the patients' underlying diseases, with the former being significantly more common in urban areas. Regarding the purpose of the home transfusions, haematologists focused on symptom improvement, whereas gastroenterology surgeons focused on life support. Furthermore, maintenance of life was more likely to be the aim in the group of patients with the lowest level of activities of daily living. The main items that were significantly associated with a low haemoglobin level before transfusion included age ≥90 years and a gastroenterologist being the physician in charge. Home transfusions were found to be performed in a restrictive and diverse manner in Japan. Life support is the second most common purpose of home transfusion in Japan, and optimizing effective home transfusion remains a challenge.

Management system of home transfusion in Japan: A nationwide survey in 2019.

In Japan, there are various opinions on the pros and cons of home transfusion because of safety concerns. We hence aimed to elucidate the safety and availability of home transfusion in Japan, which has not been clarified to date. Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The analysis period was February to December 2019. Basic information about the clinics, their collaboration system with core hospitals, storage method of red blood cells (RBCs) and the system for the management of patient information regarding transfusion reactions were investigated. Detailed information was obtained regarding the implementation of home transfusions by 51 clinics. The proportion of home care clinics performing home transfusions was 17.6%, and they were more frequently performed in urban regions. Approximately half of the clinics collaborated with a core hospital for emergency responses to transfusion reactions. At 84% of the clinics, RBC units were stored in refrigerators that were not exclusively allocated to blood storage. Nurses and family members were involved as patient attendants in 83% and 77% of the home transfusions, respectively. No serious transfusion reactions were reported among the 150 patients in 2019, nor the 623 patients up to 2018. From data on its availability and safety, home transfusions are considered to be in the developing phase in Japan. Increased cooperation between hospitals and clinics is crucial towards improving the home transfusion system in Japan in the future.

Haematological patients' perception of home transfusions: Effect of the COVID-19 pandemic.

The COVID-19 pandemic has led to a growing interest in hospital-at-home programmes, including home transfusion services. We studied whether the pandemic had influenced patients' perception of home transfusions. We conducted a survey among haematology patients who receive transfusions in the hospital day care facility. Patients were asked about the burden of day care transfusions and whether they would prefer receiving home transfusions. The survey was conducted during the COVID-19 pandemic, and the results were compared with a survey performed before the pandemic (baseline). Sixty patients were included in the COVID-19 cohort and 31 patients in the baseline cohort. There was a non-significant decrease in the proportion of patients willing to receive home transfusions during the pandemic compared with baseline (35% vs. 47%, respectively, p=0.28). More patients in the COVID-19 cohort were afraid to receive home transfusions (60% compared with 48% at baseline, p=0.29), and fewer patients believed that hospital transfusion impaired their quality of life (19% compared with 36% at baseline, p=0.09). These unexpected results may be partly attributed to the shorter time needed to arrive at the hospital during the pandemic and a greater fear of having transfusion-related adverse effects at home. Our results show that the pandemic did not increase the willingness of patients to receive home transfusions, with a non-significant drift towards refusal of home transfusions. Patients' opinions should be taken into consideration when planning for future home transfusion services, by creating a comprehensive approach to patients' needs.

Early and out-of-hospital use of COVID-19 convalescent plasma: An international assessment of utilization and feasibility.

Background and ObjectivesThe use of coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) in the treatment of patients with severe acute respiratory syndrome‐2 infection has been controversial. Early administration of CCP before hospital admission offers a potential advantage. This manuscript summarizes current trials of early use of CCP and explores the feasibility of this approach in different countries.Materials and MethodsA questionnaire was distributed to the International Society of Blood Transfusion (ISBT) CCP working group. We recorded respondents' input on existing trials on early/outpatient CCP and out‐of‐hospital (OOH)/home transfusion (HT) practices in their countries and feedback on challenges in initiating home CCP infusion programmes. In addition, details of existing trials registered on clinicaltrials.gov were summarized. ResultsA total of 31 country representatives participated. Early/OOH CCP transfusion studies were reported in the United States, the Netherlands, Spain and Brazil. There were a total of six published and five ongoing trials on the prophylactic and therapeutic early use of CCP. HT was practised in Australia, the UK, Belgium, France, Japan, Nigeria, the Netherlands, Spain, Italy, Norway, the United States and some provinces in Canada. Thirty‐four representatives indicated a lack of OOH CCP or HT in their institutions and countries. Barriers to implementation of OOH/HT included existing legislation, lack of policies pertaining to outpatient transfusion, and associated logistical challenges, including lack of staffing and resources.ConclusionEarly administration of CCP remains a potential option in COVID‐19 management in countries with existing OOH/HT programmes. Legislation and regulatory bodies should consider OOH/HT practice for transfusion in future pandemics.

Home Delivery: Transfusion Services When and Where They Are Needed.

Home blood product transfusion has been utilized around the world in various forms over the past few decades. There is current interest in decentralizing hospital care to improve patient independence and convenience, minimize cost to the health service, and to prevent nosocomial infection, especially with the recent COVID-19 pandemic. The transition to "hospital in the home" is occurring across the healthcare sector driven by aims to improve patient outcomes and patient satisfaction, capacity pressures in the acute care sector, and most recently due to concerns regarding infectious disease transmission in hospital settings. This review explores the published literature on home red cell and platelet transfusions, and where the literature is limited, also considered data from subcutaneous immunoglobulin studies. Current published experience on red cell and platelet transfusion at home has identified benefits to the patient and health service, with further studies needed to quantify improvement in quality of life and health-related outcomes. Safety concerns may be a perceived barrier to implementation of home transfusion, however current published data suggests serious adverse reactions are rare. Cost-effectiveness data for home transfusion are very limited and a key area for future research. Home transfusion has the potential to benefit from newer technologies, such as portable/remote monitoring and electronic patient identifiers.

Safety and Feasibility of Home Transfusions in Pediatric Palliative Care: A Preliminary Report

BackgroundWhile hematological symptoms are considered difficult to manage in a Pediatric Palliative Care setting, home may still represent a safe and convenient place for transfusions in patients with advanced malignancy or chronic conditions. This research focuses on the safety and feasibility of a home transfusion program. MethodsThis is a case series of patients between 0 and 18 years diagnosed with advanced malignancy or incurable chronic conditions and eligible to Pediatric Palliative Care who received home platelet or packed red cell transfusions. For all patients, we recorded adverse events such as acute hemolytic reactions, allergic reactions, or any emergency condition requiring hospital admission, equipment failure, blood product transport or storage errors, errors in patient identification, and personnel safety issues. We explored parental satisfaction with a Likert-type questionnaire and short open questions. ResultsWe reviewed 101 transfusion procedures for six patients in Pediatric Palliative Care performed by the Regional Pediatric Palliative Care network between 2014 and 2020. We did not report any adverse effects. Families reported satisfaction and a sense of safety and positively evaluated the opportunity of having transfusion at home to minimize the disruption in everyday life. The cost analysis resulted in a consistent saving for the Regional Health System. ConclusionThis study supports the safety and feasibility of home transfusion in Pediatric Palliative Care.

Remote vital signs data monitoring during home blood transfusion: A pilot study.

Background and aimsOur study aimed to establish safer methods to manage home blood transfusion by using a remote vital signs data monitoring system. Home care is administered for patients with various medical disorders; however, home blood transfusion remains challenging owing to the risk of transfusion‐related complications.MethodsWe set up a remote vital signs data monitoring system to improve the safety of home blood transfusions. Using an Internet‐based vital signs data monitoring system, the heart rate, electrocardiography, respiration rate, and percutaneous oxygen saturation (SpO2) were monitored and recorded during the entire home transfusion period.ResultsTen transfusions in three patients were monitored; two of the patients had an abnormality in a single vital sign (decreased SpO2 decrease and increased respiratory rate); these were not transfusion‐related complications. Vital sign anomalies also occur because of errors in using the measurement device and noise associated with body movements. The presence of abnormalities in at least two vital signs among SpO2 decrease, tachycardia, and increased respiratory rate that persisted for >5 minutes was defined as a complicated vital sign abnormality (CVSA). There were no severe transfusion‐related complications with CVSA in the present study.ConclusionThis study indicates the feasibility and sustainability of real‐time remote monitoring of vital signs for the safety of home transfusion. Although CVSA may function as an indicator of severe transfusion‐related complications, these findings need to be confirmed with further studies.

Willingness and concerns of transfusion-dependent hematological patients toward the option of home transfusion therapy

Background: One of the main obstacles of providing home-based palliative care to transfusion-dependent hematology patients is the lack of home transfusions services. While healthcare professionals are concerned with safety and cost of home transfusions, the attitude of the patients toward home transfusions are mostly unknown. Aim: To obtain quantitative data regarding the willingness and concerns of transfusion-dependent patients with hematological diseases toward the option of home transfusions. Design: A cross sectional survey including a self-administered questionnaire in one of the three main spoken languages in Israel was administered to patients in 17 hospital hematology outpatient clinics between May 2019 and March 2020. Results: About 52% of 385 patients that participated in the survey preferred home transfusions to hospital transfusions. Gender, age, education, or type of disease were not associated with preference for home transfusions, nor were hospital location or its size. The likelihood to prefer home transfusions was significantly higher among the Hebrew-speakers and those who had not experienced adverse effects previously. The most significant factor associated with preference of home transfusions was a perceived negative effect of hospital-based transfusion on quality of life. The main reason to reject home transfusions was fear of possible adverse effects and concerns over losing contact with the medical staff at the treating hospital. Conclusion: These data suggest that a significant portion of transfusion-dependent patients in Israel view home transfusions as a preferred treatment option and that its successful implementation requires maintaining ongoing contact with the treating hospital.

Temperature Management of Red Blood Cell Solution Transported by Car for Transfusion at Home

Objective: In Japan, red blood cell (RBC) solution is usually transported by car from a medical institution to the patient’s house for home transfusion. However, there are no regulations for transporting blood by car in the medical setting. Therefore, we assessed and compared the methods (containers) used for transporting the RBC solution by car. Materials and Methods: Irradiated RBC solution samples (280 mL) supplied by the Japan Red Cross Society were each divided into two bags. The quality of blood transported by car (1 - 2 hours) in an active transport refrigerator (ATR) (control group) was compared with that transported in a cooler, or styrofoam box (study group). We tested the hemolytic effects of transportation by car, storage, and filtration through a transfusion set on the lactate dehydrogenase (LD) levels in the RBC solutions. Results: Post-filtered LD levels were significantly higher in the RBC solutions transported in a cooler-box with inadequate temperature control when compared to those transported in an ATR with optimal temperature control. However, under conditions of optimal temperature control, the post-filtered LD levels were comparable in the control and study (both cooler and styrofoam boxes) group RBC solutions. Conclusion: Temperature management is critical for the maintenance of the quality of the RBC solution transported by car.

Home transfusion: three decades of practice at a tertiary care hospital.

Hospital at Home (HH) provides specialized care at the patients' homes. Keeping patients in familial surroundings can result in better outcomes reducing readmission to hospital, mortality, and costs of care. Home transfusion (HT) can be a key element in HH management but is scarcely deployed due to concerns about safety and cost. We have reviewed our HT practice to assess its feasibility and safety. We prospectively reviewed data collected from 1985 to 2015, focusing specially on feasibility and procedural safety, looking for adverse events of transfusion. We also assessed the situation in similar hospitals in Spain with a survey about their practice. A total of 613 patients received 2260 blood components in 2126 transfusion episodes. A total of 93% patients received fewer than 10 transfusions. Most patients were treated for blood diseases (32%) or cancers (20%). The rate of adverse effects was 2.68% and decreased significantly with time. Fever was the most common adverse reaction. Patients who received transfusion of more than one blood product in a day were at higher risk of adverse events. No errors or near-miss events were detected, and no patient had to be readmitted to hospital for this cause. The survey on HT practices in similar hospitals showed great variation in practice. HT is feasible, sustainable, and safe, when performed on selected patients by dedicated HH units with well-trained staff, under specific protocols.

Home blood transfusion: a necessary service development

An alternative to the transfusion of blood and platelets in hospital was assessed with the aim of reducing the demand on acute services and the need for hospital admission. Patients and general practitioners [GPs] were surveyed before a home blood transfusion service was set up. The majority of GPs and patients did not support the scheme initially. After the service was set up, all patients who received home transfusion stated that this was more convenient. We feel that by avoiding unnecessary emergency admissions, which account for up to 40% of all admissions to NHS hospitals, and improving the capacity of our day unit, we are providing a better service for local patients. More widespread use of home transfusion services should be encouraged.

Nationwide survey of home transfusion practices.

Limited information exists on home transfusion practices. In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non-AABB home health care agencies that provide out-of-hospital transfusions. Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions. Most of the 50 respondents with a home transfusion program are licensed by their state and accredited by the Joint Commission on Accreditation of Healthcare Organizations. All respondents have written policies for home transfusion, and 90 percent require a signed informed-consent document before initiating transfusions in the home. Most have policies requiring that there be a second adult and a telephone in the home, that the home be deemed safe for transfusion, that the patient's physician be readily available, and that the patient have had prior transfusions. The most common component issued by the blood providers was red cells, followed by platelets. White cell-reduced components were always provided by 36 percent of respondents. The most common patient diagnosis was cancer. Home transfusions were provided primarily by registered nurses. Only 14 percent of respondents indicated that the medical director of the blood bank is responsible for approving a patient for home transfusion. A posttransfusion visit is performed by 46 percent of respondents. Although most facilities have policies for the administration of home transfusions, there remains marked heterogeneity among blood providers and transfusionists regarding home transfusion practices.

Patients' attitudes regarding out-of-hospital blood transfusion.

While the administration of blood transfusions outside of the hospital has become more prevalent, little is known about patients' attitudes regarding this practice. Twenty-nine adult patients who regularly received blood transfusions in a hospital's outpatient clinic and had never received home transfusions were surveyed. Linear analogue and categorical monetary scales were used to evaluate their responses to a series of questions. At the time of the survey, 27 study participants (93%) did not want home transfusions, and 21 (72%) thought home transfusions posed a greater risk than hospital based transfusion. More than half (56%) of the participants were unwilling to pay more for a home transfusion for themselves than for an outpatient hospital-based transfusion. Participants were willing to pay more for a home blood transfusion for a hypothetical patient requesting transfusions at home. The lack of available transportation and poor patient health were identified as important factors in determining how much more they would be willing to pay for transfusions at home. While blood transfusions at home may become more accessible, many patients may prefer to receive their transfusions in the hospital, probably because home transfusions are thought to pose a greater risk. A patient's health and the availability of transportation were determined to be important factors in decisions about how much more money to spend for transfusions at home than for those in an outpatient hospital setting.

Establishing a community-based home transfusion program

Blood transfusions are now safely given in the home. The author gives practical information regarding this service. The blood bank, the home health agency, the physician, the patient, and the nurse are all members of the team involved in the administration of transfusions in the home setting. Included in this article are an outline of the nurse's role, a list of blood components suitable for home administration, a sample flow sheet, and a list of adverse reactions and symptoms.

Home transfusion for the cancer patient

Home transfusion for the cancer patient

Home Blood Transfusions: The Medical, Economic, and Legal Issues Surrounding a New Treatment Procedure

Blood transfusions have almost always been confined to hospital settings in the past. Recent medical care trends have shifted some therapies (e.g., renal dialysis, hemophilia treatment) into the patient's home. Transfusions are now being given in increasing numbers to stable patients in their homes. This paper examines the medical aspects, the economic issues, and the legal implications of such transfusions. Candidates for home transfusion must be carefully chosen primarily according to the medical guidelines for such treatment. Any legal issues must be satisfactorily answered before approval is given. The paper concludes that if done properly, home transfusions can be safe, cost-effective, and convenient for a carefully selected segment of patients.

Book Reviews

Journal Article Book Reviews Get access Microcomputer Applications in the Clinical Laboratory, McNeely Michael D.D. MD. Chicago, ASCP Press, 1987, 366 pages, $31.50.Malignant Lymphoma, edited by Berard Costan W. MD; Dorfman Ronald F. MD, FRCPath; and Kaufman Nathan MD. Baltimore, Williams and Wilkins, 1987, 300 pages, $60.50.Home Transfusion Therapy, edited by Snyder Edward L. MD, and Menitove Jay E. MD. Arlington, Va, American Association of Blood Banks, 1986, 80 pages, $17.00.Introduction to Medical Laboratory Technology, Baker F. J., OBE, FIMLS, R. E. Silverton, FIMLS, FBIM, with D. Kilshaw, FIMLS, CBiol, MTBiol. London, Butterworth Publishers, 1985, 6th ed, 408 pages, $39.95. Byron A. Myhre, MD, PhD, Harbor-UCLA, Byron A. Myhre, MD, PhD, Harbor-UCLA Search for other works by this author on: Oxford Academic PubMed Google Scholar James J. Butler, MD, M.D., James J. Butler, MD, M.D. Search for other works by this author on: Oxford Academic PubMed Google Scholar Janet L. Jaques, RN, BSN, Janet L. Jaques, RN, BSN Search for other works by this author on: Oxford Academic PubMed Google Scholar Polly Hutton, MT(ASCP)SC Polly Hutton, MT(ASCP)SC Search for other works by this author on: Oxford Academic PubMed Google Scholar Laboratory Medicine, Volume 18, Issue 12, 1 December 1987, Pages 869–870, https://doi.org/10.1093/labmed/18.12.869 Published: 01 December 1987

Home Transfusion Therapy: A New Dimension In Home Care

Visiting Nurse Service, Inc (VNS), of Akron, Ohio, has provided transfusion therapy in the home since January 1984. Home transfusion has proved a valuable alternative to inpatient treatment and to expensive, exhausting ambulance trips to the hospital for outpatient treatment for selected homebound patients, many of whom are terminally ill. The VNS program is based on detailed policies and procedures that include patient referral criteria, RN education, patient education, blood procurement and labelling, and protocols for transfusion complications. Recognizing the need for patient safety, VNS has a quality assurance program that provides for continuous monitoring and evaluation of the home transfusion therapy, especially of any adverse reactions that occur.