A multicenter pilot-randomized controlled trial of the feasibility of an augmented red blood cell transfusion strategy for patients treated with induction chemotherapy for acute leukemia or stem cell transplantation.
BACKGROUND
Anemia may be an important factor contributing to an increased risk of bleeding, particularly in patients with thrombocytopenia.


METHODS
A multicenter, single-blinded pilot randomized controlled trial (RCT) was performed to evaluate the feasibility of conducting a larger RCT to determine the effect of the hemoglobin (Hb) concentration on bleeding risk. Patients with acute leukemia receiving induction chemotherapy or those undergoing stem cell transplantation were assigned to one of two treatment groups: standard transfusion strategy (transfusion of 2 units of red blood cells [RBCs] when their Hb level was less than 80 g/L) or an augmented transfusion strategy (transfusion of 2 units of RBCs when their Hb level was less than 120 g/L).


RESULTS
Sixty patients were enrolled: 29 in the control group and 31 in the experimental group. The proportions of patients experiencing clinically significant bleeding and the time to first bleed were not significantly different between the control and experimental groups. The experimental group received more RBC transfusions (transfusions/patient-day) than the control group (0.233 vs. 0.151; relative risk, 1.56; 95% confidence interval, 1.16-2.10; p = 0.003). The proportion of patient-days with platelet (PLT) transfusions was not different between the experimental and control groups. The mean number of donor exposures (PLT and RBC transfusions) was not different between experimental and control groups. Bleeding symptoms were systematically documented.


CONCLUSIONS
This pilot study thus indicated that it would be feasible to enroll the required number of patients to enable the performance of a large RCT to investigate the effect of Hb on bleeding risk in thrombocytopenic patients.
Webert
Kathryn E
KE
Department of Medicine, McMaster University, Hamilton, Ontario, Canada. webertk@mcmaster.ca
Cook
Richard J
RJ
Couban
Stephen
S
Carruthers
Julie
J
Lee
Ker-Ai
KA
Blajchman
Morris A
MA
Lipton
Jeffrey H
JH
Brandwein
Joseph M
JM
Heddle
Nancy M
NM
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
D000970:Antineoplastic Agents; D006454:Hemoglobins