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Published on: September 6, 2017
Patient Blood Management after Hematopoietic Stem Cell Transplantation in a Pediatric Setting: Starting Low and Going
Claudia Del Fante1, Cristina Mortellaro1, Santina Recupero2
1Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Insights
Pediatric hematopoietic stem cell transplant (HSCT) patients can receive fewer red blood cell (RBC) and platelet (PLT) transfusions with a restrictive transfusion strategy. This approach did not negatively impact patient outcomes, supporting patient blood management programs.
Area of Science:
- Hematology
- Pediatric Oncology
- Transfusion Medicine
Background:
- Optimal transfusion strategies for pediatric hematopoietic stem cell transplantation (HSCT) patients are not well-established.
- Substantial transfusion requirements are common in HSCT, necessitating research into best practices.
- A shift towards a more restrictive transfusion approach was implemented in 2016.
Purpose of the Study:
- To retrospectively analyze red blood cell (RBC) and platelet (PLT) transfusion practices in pediatric HSCT patients.
- To evaluate the impact of a restrictive transfusion strategy on patient outcomes within the first 100 days post-HSCT.
- To assess changes in transfusion thresholds and utilization over a four-year period (2016-2019).
Main Methods:
- Retrospective analysis of 146 pediatric HSCT patients.
- Review of RBC and PLT transfusion practices and thresholds.
- Evaluation of patient outcomes, including non-relapse mortality and adverse events.
- Comparison of transfusion data before and after the adoption of a restrictive strategy.
Main Results:
- Significant decrease in Hb threshold for RBC transfusions (7.8 to 7.3 g/dL) and PLT threshold (18,000 to 16,000/μL) from 2016 to 2017.
- Continued decrease in PLT threshold to 15,000/μL by 2019.
- Low utilization of RBC and PLT transfusions in patients without hemorrhagic complications.
- No increase in 100-day or 180-day non-relapse mortality or adverse events observed.
- No deaths attributed to hemorrhagic complications.
Conclusions:
- A restrictive transfusion strategy in pediatric HSCT patients is associated with reduced transfusion utilization.
- This approach appears safe, with no observed negative impact on key patient outcomes.
- Findings support the implementation of patient blood management programs for HSCT recipients.
- Further robust studies are warranted to confirm these preliminary observations.
Abstract:
Despite the substantial transfusion requirements, there are few studies on the optimal transfusion strategy in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Our study aimed to retrospectively analyze red blood cell (RBC) and platelet (PLT) transfusion practices during the first 100 days after HSCT at the pediatric hematology/oncology unit of our hospital between 2016 and 2019, due to a more restrictive approach adopted after 2016. We also evaluated the impact on patient outcomes. A total of 146 consecutive HSCT patients were analyzed. In patients without hemorrhagic complications, the Hb threshold for RBC transfusions decreased significantly from 2016 to 2017 (from 7.8 g/dL to 7.3 g/dL; p = 0.010), whereas it remained the same in 2017, 2018, and 2019 (7.3, 7.2, and 7.2 g/dL, respectively). Similarly, the PLT threshold decreased significantly from 2016 to 2017 (from 18,000 to 16,000/μL; p = 0.026) and further decreased in 2019 (15,000/μL). In patients without severe hemorrhagic complications, the number of RBC and PLT transfusions remained very low over time. No increase in 100-day and 180-day non-relapse mortality or adverse events was observed during the study period. No patient died due to hemorrhagic complications. Our preliminary observations support robust studies enrolling HSCT patients in patient blood management programs.
