title: Impact of a conservative red blood cell transfusion strategy in children undergoing hematopoietic stem cell transplantation.
abstract: A 2008 randomized trial of critically ill, but stable, children reported the safety of transfusing red blood cells at a hemoglobin threshold of 7 g/dL. In 2009, we adopted the same transfusion criteria in our hematopoietic stem cell transplantation patients. Regression modeling was used to compare data obtained during primary admission for hematopoietic stem cell transplantation in calendar years before and after our practice change. Sixty-six patients admitted in the preintervention year were compared with 75 postintervention. Pre- and postpatients were similar in diagnoses and type of transplantations. Postintervention, median hemoglobin pretransfusion significantly decreased from 8.8 g/dL to 6.8 g/dL (P < .0001). In addition, transfused red blood cell units received by patients dropped from 4 (interquartile range [IQR] 3, 8) to 3 (IQR, 2, 5), (P = .002), and number of transfusion days per patients decreased from 4 (IQR, 2,5) to 3 (IQR, 2, 5), (P = .01). There were no differences in length of stay, time to engraftment, or 100-day mortality. Median blood product charges per patient significantly decreased ($3,624 [IQR, $2,265, $6,040] to $2,185 [IQR, $1,812, $3,997], P = .004). Our initial experience suggests that implementation of a conservative transfusion strategy in otherwise stable children undergoing hematopoietic stem cell transplantation appears safe and lowers transfusion exposures.
authors.affiliation: Department of Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA. jenifer.lightdale@childrens.harvard.edu
authors.forename: Jenifer R
authors.initials: JR
authors.lastname: Lightdale
authors.forename: Adrienne G
authors.initials: AG
authors.lastname: Randolph
authors.forename: Chau M
authors.initials: CM
authors.lastname: Tran
authors.forename: Hongyu
authors.initials: H
authors.lastname: Jiang
authors.forename: Andrea
authors.initials: A
authors.lastname: Colon
authors.forename: Kathleen
authors.initials: K
authors.lastname: Houlahan
authors.forename: Amy
authors.initials: A
authors.lastname: Billet
authors.forename: Steven
authors.initials: S
authors.lastname: Sloan
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Lehmann
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000191:economics / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006454:Hemoglobins / Q000032:analysis*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008223:Lymphoma; D008297:Male; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D016019:Survival Analysis
chemical_list: D006454:Hemoglobins