title: Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States.
abstract: Transfusion of blood products is a key component of the supportive management in patients with acute leukemia (AL). However high-quality trial evidence and clinical outcome data to support specific transfusion goals for blood products for patients with AL remain limited leading to diverse transfusion practices. The primary objective of this study was to determine the spectrum of transfusion patterns in a variety of care settings among providers who treat AL patients.
  
  
  
  A 31-question survey queried providers caring for AL patients about the existence of institutional guidelines for transfusion of blood products, transfusion triggers for hemoglobin (Hb), platelets (PLTs), and fibrinogen in various settings including inpatient and outpatient and before procedures.
  
  
  
  We analyzed 130 responses and identified divergent transfusion Hb goals in hospitalized and ambulatory patients, fibrinogen goals for cryoprecipitate transfusions, and variation in practice for use of certain PLTs and red blood cell products. The least variable transfusion patterns were reported for PLT goals in thrombocytopenia and in the setting of invasive procedures such as bone marrow biopsy and lumbar punctures.
  
  
  
  This survey confirmed wide variations in blood product transfusion practices across several clinical scenarios in patients with AL. The findings emphasized the need for large prospective randomized trials to develop standardized evidence-based guidelines for blood product transfusions in patients with AL with the goal of limiting unnecessary transfusions without compromising outcomes.
authors.affiliation: Yale New Haven Hospital, Cleveland, Ohio.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Pine
authors.affiliation: Department of Internal Medicine, Section of Hematology, Cleveland, Ohio.
authors.forename: Eun-Ju
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Leukemia Program, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mikkael
authors.initials: M
authors.lastname: Sekeres
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: David P
authors.initials: DP
authors.lastname: Steensma
authors.affiliation: Yale University School of Public Health, New Haven, Connecticut.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zelterman
authors.affiliation: Department of Internal Medicine, Section of Hematology, Cleveland, Ohio.
authors.forename: Thomas
authors.initials: T
authors.lastname: Prebet
authors.affiliation: The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Amy
authors.initials: A
authors.lastname: DeZern
authors.affiliation: Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida.
authors.forename: Rami
authors.initials: R
authors.lastname: Komrokji
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Mark
authors.initials: M
authors.lastname: Litzow
authors.affiliation: Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Selina
authors.initials: S
authors.lastname: Luger
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Richard
authors.initials: R
authors.lastname: Stone
authors.affiliation: University of Alabama, Birmingham, Alabama.
authors.forename: Harry P
authors.initials: HP
authors.lastname: Erba
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
authors.affiliation: Department of Internal Medicine, Section of Hematology, Cleveland, Ohio.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Section of Hematology, Cleveland, Ohio.
authors.forename: Nikolai A
authors.initials: NA
authors.lastname: Podoltsev
authors.affiliation: Yale New Haven Hospital, Cleveland, Ohio.
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbarotta
authors.affiliation: Yale New Haven Hospital, Cleveland, Ohio.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kasberg
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine.
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Hendrickson
authors.affiliation: Department of Internal Medicine, Section of Hematology, Cleveland, Ohio.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
authors.affiliation: Department of Internal Medicine, Section of Hematology, Cleveland, Ohio.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016913:Blood Component Transfusion; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013921:Thrombocytopenia / Q000628:therapy; D014481:United States