July 27, 2017
World's First Study
This is the world's first study to look at the impact of a Patient Blood Management (PBM) Program on transfusion use and outcomes in patients with hematological malignancies (disorders of the blood and blood forming tissues, such as leukemia). Its findings have substantial implications for practice around the globe.
With aging populations around the world, the incidence of hematological disease is increasing. This patient group is the biggest consumer of blood products, accounting for about 20% of all blood donated. However, there is increasing evidence, in a wide range of patient groups including hematology, that blood transfusions may be associated with adverse patient outcomes and increased costs. There is wide variation in transfusion practice in hematology and a need for further studies to help optimize cost-effective patient care.
International health care systems are facing a major challenge to improve health care outcomes while working with increasingly restricted funding. Comprehensive PBM Programs have demonstrated the ability to improve care and patient health outcomes while reducing transfusions and achieving substantial cost savings. Building on these outcomes, the European Commission recently published two guides to assist in establishing PBM as a standard to improve patient care in EU Member States.
The study - "Blood use in patients receiving intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation: the impact of a health system-wide patient blood management program" - published this month in the journal Transfusion, looked at the impact of the Western Australia PBM Program on transfusion utilization, outcomes and costs in patients treated for hematological disease. It included 695 admissions over 3.5 years to two major hospitals. The results showed the program was associated with a 39% reduction in red blood cell transfusion and a 35% reduction in platelet transfusions. This translated to an estimated blood product related cost saving of up to US$2 million.
Blood management in hematology patients is particularly challenging and practice has been slow to change. For many reasons, including effects of the disease itself and treatment such as chemotherapy, these patients become anemic (lower than normal levels of red blood cells with the oxygen-carrying molecule hemoglobin). A normal hemoglobin level for males is greater than 13.0 g/dL and for females greater than 12.0 g/dL.
Lead author Michael Leahy, hematologist and Clinical Professor at the University of Western Australia Medical School, states "There has been a longstanding belief among hematologists that patients with leukemia undergoing chemotherapy should have a transfusion of red blood cells if their haemoglobin level drops below about 9 g/dL to help avoid adverse outcomes. Findings in this real-world non-clinical trial setting challenge that belief."
Senior author Shannon Farmer, Adjunct Research Fellow at the University of Western Australia Medical School and Scientific Associate of IFPBM said, "This study suggests that patients undergoing chemotherapy with hematological disease may tolerate much lower levels of hemoglobin than previously thought. The transfusion threshold, the hemoglobin value at which a transfusion is given, dropped significantly from 8.0 g/dL at the beginning of the study to 6.8 g/dL at the end. This was associated with significant reductions in transfusion and substantial costs savings without evidence of harm to the patients. In fact, it was associated with a trend toward improved survival."
Professor Leahy says that, if implemented in this patient population, PBM programs could have a substantial global impact, reducing blood utilization and health care service costs.