title: Impact of a Patient Blood Management Program and an Outpatient Anemia Management Protocol on Red Cell Transfusions in Oncology Inpatients and Outpatients.
abstract: BACKGROUND
  Patient blood management (PBM) programs are associated with reduced transfusion usage, reduced hospital costs, and improved patient outcomes. The application of PBM principles in patients with malignant disease might achieve similar results. However, this population presents unique challenges. The aim of the present study was to investigate the impact of a PBM program on blood usage and patient outcomes in cancer patients, particularly in the setting of restricted use of erythropoiesis-stimulating agents (ESAs).
  
  
  METHODS
  A retrospective observational study was performed of patients admitted with a primary diagnosis of malignancy treated at Eastern Maine Medical Center as inpatients or outpatients, or both, from January 2008 through July 2013.
  
  
  RESULTS
  The proportion of inpatients and outpatients receiving ESAs decreased from 2.9% in 2008 to 1.1% in 2013 (p < .001). During the same period, an increase occurred in the mean dose of intravenous (IV) iron from 447 mg (95% confidence interval [CI], 337-556) to 588 mg (95% CI, 458-718). The mean red blood cell (RBC) units transfused per inpatient and outpatient episode decreased from 0.067 to 0.038 unit (p < .001). In inpatients, significant increases occurred in the proportion of single-unit RBC transfusions (p < .001) and patients infused with IV iron (p = .02), and significant decreases in the mean pretransfusion hemoglobin (p = .02) and RBC transfusion rate (p = .04). In-hospital mortality and length of stay did not change significantly during this period.
  
  
  CONCLUSIONS
  Despite the decreased use of ESA therapy, the implementation of a PBM program and outpatient anemia management protocol in cancer patients at our medical center was associated with significant reductions in RBC usage.
authors: Eastern Maine Medical Center, Bangor, Maine, USA Accumen LLC, San Diego, California, USA igross@accumen.com.
authors: Irwin
authors: I
authors: Gross
authors: Performance Unit, South Metropolitan Health Service, Perth, Western Australia, Australia.
authors: Kevin M
authors: KM
authors: Trentino
authors: Eastern Maine Medical Center, Bangor, Maine, USA.
authors: Astrid
authors: A
authors: Andreescu
authors: Eastern Maine Healthcare Systems, Brewer, Maine, USA.
authors: Rhonda
authors: R
authors: Pierson
authors: Eastern Maine Medical Center Cancer Care, Brewer, Maine, USA.
authors: Richard A
authors: RA
authors: Maietta
authors: School of Surgery, Faculty of Medicine Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
authors: Shannon
authors: S
authors: Farmer
mesh_terms: D000368:Aged; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D010045:Outpatients; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics
keywords: Anemia; Blood transfusion; Erythropoietin; Intravenous iron; Iron deficiency; Oncology; Patient blood management