Background

Little is known about the optimal transfusion strategy in outpatients, where the goal of treatment is often to maintain quality of life. Our hypothesis is that an individualized approach is required in the outpatient setting, which may result in significant deviation of suggested transfusion triggers and volumes from established guidelines. The aim of this retrospective analysis is to describe real-world transfusion practice of red blood cell concentrates (RBC).

Methods

Data on outpatient RBC transfusions performed in the year 2022 are retrospectively collected in a single center were n=2943 red cell units were transfused. We assume that we perform at least 30-40% of outpatient RBC transfusions in our region as our blood service delivered 3460 red cell units to outpatient facilities. A total of n= 1557 RBC units given in 860 episodes are included in this interim analysis. Most patients (90%) came from an area with a travel distance of

Results

In total 1287 visits with 860 transfusion episodes in 340 patients (43% women) were analyzed. The median age was 64 (74; 83) years. No RBC was given in 217 visits with Hb levels of 9.2 (8.7;10.0) g/dl, and 1 unit in 165 episodes at 8.4 (8.1;8.6)g/dl and 2 in 691 episodes at 7.5 ±6.9;7.9 g/dl (p<0.001). The mean increase of Hb was 1.1±2.0 g/dl after 1 unit without additional transfusion of a platelet concentrate (PC) and 0.5±0.6 g/dl with additional PC transfusion, and 1.9 (±1.0) g/dl after 2 RBC units without PC and 1.5±0.8 g/dl with PC transfusion. The pre-transfusion Hb level was the same (7.6± 0.9 g/dl) in patients with or without a history of coronary heart disease and were not associated with age, travel distance or Pro-NT-BNP-levels.

Conclusion

Pre-transfusion hemoglobin values did not deviate from the suggested trigger of 7-8 g/dl in chronic red cell transfusion dependent outpatients. Prospective studies are urgently needed to better define the optimal dose in these patients.

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