Reevaluation of the medical necessity of washed red blood cell transfusion in chronically transfused adults.

Autor: Huso T; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Buban K; Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA., Van Denakker TA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Haddaway K; Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA., Smetana H; Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA., Marshall C; Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA., Rai H; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Ness PM; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Bloch EM; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Tobian AAR; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Crowe EP; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2024 Feb; Vol. 64 (2), pp. 216-222. Date of Electronic Publication: 2023 Dec 21.
DOI: 10.1111/trf.17690
Abstrakt: Background: Washing red blood cell (RBC) units mitigates severe allergic transfusion reactions. However, washing reduces the time to expiration and the effective dose. Automated washing is time- and labor-intensive. A shortage of cell processor tubing sets prompted review of medical necessity for washed RBC for patients previously thought to require washing.
Study Design and Methods: A single-center, retrospective study investigated discontinuing wash RBC protocols in chronically transfused adults. In select patients with prior requirements for washing, due to a history of allergic transfusion reactions, trials of unwashed transfusions were performed. Patient demographic, clinical, laboratory, and transfusion data were compiled. The per-unit washing cost was the sum of the tubing set, saline, and technical labor costs.
Results: Fifteen patients (median age 34 years interquartile range [IQR] 23-53 years, 46.7% female) were evaluated. These patients had been transfused with a median of 531 washed RBC units (IQR 244-1066) per patient over 12 years (IQR 5-18 years), most commonly for recurrent, non-severe allergic reactions. There were no transfusion reactions with unwashed RBCs aside from one patient with one episode of pruritus and another with recurrent pruritus, which was typical even with washed RBC. We decreased the mean number of washed RBC units per month by 72.9% (104 ± 10 vs. 28.2 ± 25.2; p < .0001) and saved US $100.25 per RBC unit.
Conclusion: Washing of RBCs may be safely reconsidered in chronically transfused patients without a history of anaphylaxis. Washing should be implemented judiciously due to potential lack of necessity and logistical/operational challenges.
(© 2023 AABB.)
Databáze: MEDLINE
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