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Differences among hemoglobin thresholds for red blood cell transfusions in patients with hematological diseases in teaching hospitals: a real world data in Japan

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Abstract

A hemoglobin (Hb) threshold level of 7 g/dL has been proposed for red blood cell (RBC) transfusion in patients with chronic anemia in the Japanese guideline since 2005. However, Hb thresholds for hematological diseases in clinical practice and factors responsible for higher Hb thresholds remain unclear. Hb thresholds were collected for patients with hematological diseases from 32 Japanese teaching hospitals. Uni- and multivariate analyses were used to analyze relationships between Hb threshold level and various patient and hospital factors. In total, 4996 units of RBC were transfused to 1054 patients with hematological diseases in 2421 transfusions. Median age was 68 years. Myelodysplastic syndrome was the most frequent diagnosis. Overall median Hb threshold level was 6.9 g/dL. Multivariate linear regression analysis detected the following variables associated with Hb threshold level: hospital; cardiovascular disease; symptomatic anemia; and hematopoietic stem cell transplantation. Hospital was the most significant factor. Collectively, median Hb threshold level in clinical practice in Japan was similar to the guidelines. Higher Hb threshold level depended on the hospitals at which the transfusions were performed as well as patient condition. Educational approaches directed toward hospitals may be useful to promote transfusion guidelines.

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References

  1. Lacroix J, Hebert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356:1609–19.

    Article  CAS  Google Scholar 

  2. Webert KE, Cook RJ, Couban S, Carruthers J, Lee KA, Blajchman MA, et al. 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. Transfusion. 2008;48:81–91.

    CAS  PubMed  Google Scholar 

  3. Foss NB, Kristensen MT, Jensen PS, Palm H, Krasheninnikoff M, Kehlet H. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion. 2009;49:227–34.

    Article  Google Scholar 

  4. Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010;304:1559–677.

    Article  CAS  Google Scholar 

  5. Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365:2453–62.

    Article  CAS  Google Scholar 

  6. Cooper HA, Rao SV, Greenberg MD, Rumsey MP, McKenzie M, Alcorn KW, et al. Conservative versus liberal red cell transfusion in acute myocardial infarction (the CRIT randomized pilot study). Am J Cardiol. 2011;108:1108–11.

    Article  Google Scholar 

  7. Carson JL, Brooks MM, Abbott JD, Chaitman B, Kelsey SF, Triulzi DJ, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J. 2013;165(964–971):e961.

    Google Scholar 

  8. Parker MJ. Randomised trial of blood transfusion versus a restrictive transfusion policy after hip fracture surgery. Injury. 2013;44:1916–8.

    Article  Google Scholar 

  9. Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368:11–21.

    Article  CAS  Google Scholar 

  10. Walsh TS, Boyd JA, Watson D, Hope D, Lewis S, Krishan A, et al. Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial. Crit Care Med. 2013;41:2354–63.

    Article  Google Scholar 

  11. Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. 2014;371:1381–91.

    Article  Google Scholar 

  12. de Almeida JP, Vincent JL, Galas FR, de Almeida EP, Fukushima JT, Osawa EA, et al. Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial. Anesthesiology. 2015;122:29–38.

    Article  Google Scholar 

  13. Gregersen M, Borris LC, Damsgaard EM. Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture: the TRIFE randomized controlled trial. Acta Orthop. 2015;86:363–72.

    Article  Google Scholar 

  14. Jairath V, Kahan BC, Gray A, Dore CJ, Mora A, James MW, et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet. 2015;386:137–44.

    Article  Google Scholar 

  15. Murphy GJ, Pike K, Rogers CA, Wordsworth S, Stokes EA, Angelini GD, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med. 2015;372:997–1008.

    Article  CAS  Google Scholar 

  16. DeZern AE, Williams K, Zahurak M, Hand W, Stephens RS, King KE, et al. Red blood cell transfusion triggers in acute leukemia: a randomized pilot study. Transfusion. 2016;56:1750–7.

    Article  CAS  Google Scholar 

  17. Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. 2016;316:2025–35.

    Article  Google Scholar 

  18. Patient Blood Management Guidelines: Module 3. Medical.(effecttive August 27, 2019).https://www.blood.gov.au/pbm-module-3.

  19. Boral LI, Bernard A, Hjorth T, Davenport D, Zhang D, MacIvor DC. How do I implement a more restrictive transfusion trigger of hemoglobin level of 7 g/dL at my hospital? Transfusion. 2015;55:937–45.

    Article  CAS  Google Scholar 

  20. Frank SM, Resar LM, Rothschild JA, Dackiw EA, Savage WJ, Ness PM. A novel method of data analysis for utilization of red blood cell transfusion. Transfusion. 2013;53:3052–9.

    Article  Google Scholar 

  21. Klaus SA, Frank SM, Salazar JH, Cooper S, Beard L, Abdullah F, et al. Hemoglobin thresholds for transfusion in pediatric patients at a large academic health center. Transfusion. 2015;55:2890–7.

    Article  CAS  Google Scholar 

  22. Blood Services 2018 (effecttive March 11, 2019). https://www.jrc.or.jp/english/pdf/Blood_Services_2018_web.pdf.

  23. Aapro M, Beguin Y, Bokemeyer C, Dicato M, Gascon P, Glaspy J, et al. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29:96–110.

    Article  Google Scholar 

  24. Frank S, Savage W, Rothschild J, Rivers R, Ness P, Paul S, et al. Variability in blood and blood component utilization as assessed by an anesthesia information management system. Anesthesiology. 2012;117:99–106.

    Article  Google Scholar 

  25. Yazer M, Waters J. How do I implement a hospital-based blood management program? Transfusion. 2012;52:1640–5.

    Article  Google Scholar 

  26. Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, et al. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol. 2016;172:187–207.

    Article  Google Scholar 

  27. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)

  28. Myelodysplastic Syndromes (effecttive August 23, 2019) https://www.nccn.org/professionals/physician_gls/default.aspx.

  29. Tay J, Tinmouth A, Fergusson D, Allan D. Transfusion of red cells in hematopoietic stem cell transplantation (TRIST): study protocol for a randomized controlled trial. Trials. 2011;12:207.

    Article  Google Scholar 

  30. Bercovitz RS, Quinones RR. A survey of transfusion practices in pediatric hematopoietic stem cell transplant patients. J Pediatr Hematol Oncol. 2013;35:e60–63.

    Article  Google Scholar 

  31. Favre G, Fopp M, Gmur J, Tichelli A, Fey MF, Tobler A, et al. Factors associated with transfusion requirements during treatment for acute myelogenous leukemia. Ann Hematol. 1993;67:153–60.

    Article  CAS  Google Scholar 

  32. Spradbrow J, Cohen R, Lin Y, Armali C, Collins A, Cserti-Gazdewich C, et al. Evaluating appropriate red blood cell transfusions: a quality audit at 10 Ontario hospitals to determine the optimal measure for assessing appropriateness. Transfusion. 2016;56:2466–76.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The following collaborators participated in this study. Tohoku University Hospital, Sendai: Dr. Minami Fujiwara; Hyogo Cancer Center, Hyogo: Dr. Hiroshi Gomyo; Hokkaido University, Sapporo: Eiko Hayase; University of Yamanashi, Yamanashi (present address: Tokyo Medical University): Dr. Makoto Kaneko; Gifu University Graduate School of Medicine, Gifu: Dr. Jyun-ichi Kitagawa; Fukuoka University Hospital, Fukuoka: Dr. Midori Kumagawa; Inoue Memorial Hospital, Chiba: Dr. Yasuhiro Matsuura; Usui Hospital, Annaka: Dr. Kumiko Matsumoto; Japanese Red Cross Kitami Hospital, Kitami: Dr. Takahiro Nagashima; Tokushima Prefectural Central Hospital, Tokushima: Dr. Shuuji Ozaki; National Defense Medical College, Tokorozawa: Dr. Ken Satoh; Toho University Medical Center Sakura Hospital, Chiba: Dr. Naomi Shimizu; Toho University Medical Center Omori Hospital, Tokyo: Dr. Noritsugu Shiono; Japan Red Cross Musashino Hospital, Tokyo: Dr. Hina Takano; The Jikei University Hospital, Tokyo: Dr. Tetsunori Tasaki; Hiroshima University Hospital, Hiroshima: Dr. Naoya Yamasaki; Iwate Prefectural Isawa Hospital, Oshu-shi: Dr. Kozue Yoshida; Hyogo College of Medicine, Nishinomiya: Dr. Satoshi Yoshihara. The authors all thank Takahiko Kodama for his support of this study.

Funding

This study was supported by the Japan Society of Transfusion Medicine and Cell Therapy.

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Authors and Affiliations

  1. Division of Blood Transfusion Service, Gunma University Hospital, Gunma University School of Medicine , 3-39-15 Showa, Maebashi, Gunma, 371-8511, Japan

    Akihiko Yokohama

  2. Clinical Study Supporting Committee, The Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan

    Akihiko Yokohama, Shin-ichiro Fujiwara, Yuichi Hasegawa, Asashi Tanaka, Keizo Fujino, Mayumi Matsumoto, Shigeyoshi Makino, Shuichi Kino, Akihiro Takeshita & Kazuo Muroi

  3. Division of Transfusion and Cell Therapy, Tokyo Metropolitan Komagome Hospital, Bunkyo, Tokyo, Japan

    Yoshiki Okuyama

  4. Department of Hematology and Oncology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan

    Yasunori Ueda

  5. Clinical Laboratory, Narita Red Cross Hospital, Narita, Chiba, Japan

    Masumi Itoh

  6. Division of Hematology, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan

    Shin-ichiro Fujiwara

  7. Department of Transfusion Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan

    Yuichi Hasegawa

  8. Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan

    Kazuhiro Nagai

  9. Division of Clinical Laboratory, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Kimika Arakawa

  10. Department of Transfusion and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Koji Miyazaki

  11. Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan

    Masanori Makita

  12. Department of Hematology, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan

    Mai Watanabe

  13. Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan

    Kazuhiko Ikeda

  14. Transfusion Medicine, Hachioji Medical Center of Tokyo Medical University, Hachioji, Tokyo, Japan

    Asashi Tanaka

  15. Department of Transfusion Medicine, Osaka City University Hospital, Osaka, Japan

    Keizo Fujino

  16. Department of Nursing, Shinko Hospital, Kobe, Hyogo, Japan

    Mayumi Matsumoto

  17. Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Minato, Japan

    Shigeyoshi Makino

  18. Japanese Red Cross Hokkaido Block Blood Center, Sapporo, Hokkaido, Japan

    Shuichi Kino

  19. Department of Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Akihiro Takeshita

  20. Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan

    Kazuo Muroi

Authors
  1. Akihiko Yokohama
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  2. Yoshiki Okuyama
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  3. Yasunori Ueda
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  4. Masumi Itoh
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  5. Shin-ichiro Fujiwara
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  6. Yuichi Hasegawa
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  8. Kimika Arakawa
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  9. Koji Miyazaki
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  10. Masanori Makita
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  11. Mai Watanabe
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  12. Kazuhiko Ikeda
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  13. Asashi Tanaka
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  14. Keizo Fujino
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  15. Mayumi Matsumoto
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  16. Shigeyoshi Makino
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  17. Shuichi Kino
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  18. Akihiro Takeshita
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  19. Kazuo Muroi
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Contributions

AY designed the conception of this study, analyzed the data, interpreted the results, and wrote the manuscript. SF, YH, KI, AT, KF, MM, SM, SK, AT, and KM designed the conception of this study and interpreted the results. AY, YO, YU, MI, SF, YH, KN, KA, KM, MM, MW, KI, AT, and KM collected the data. All authors reviewed the manuscript and approved the final version of this manuscript.

Corresponding author

Correspondence to Akihiko Yokohama.

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Yokohama, A., Okuyama, Y., Ueda, Y. et al. Differences among hemoglobin thresholds for red blood cell transfusions in patients with hematological diseases in teaching hospitals: a real world data in Japan. Int J Hematol 112, 535–543 (2020). https://doi.org/10.1007/s12185-020-02937-3

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  • DOI: https://doi.org/10.1007/s12185-020-02937-3

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