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Red blood cell transfusions for thalassemia: results of a survey assessing current practice and proposal of evidence-based guidelines.

AbstractBACKGROUND:
In the absence of curative treatment, such as stem cell transplant, regular transfusions remain the mainstay of therapy for individuals with thalassemia major, a syndrome that results from marked ineffective erythropoiesis and the resultant anemia. The primary objectives of transfusion therapy are twofold: to suppress ineffective erythropoiesis and to ensure appropriate growth and development through childhood. In practice, a number of different transfusion protocols are in use across the developed world, with on-demand transfusion still being the paradigm in most of the developing world with limited resources.
STUDY DESIGN AND METHODS:
To investigate perceived differences in transfusion practice, a self-reported electronic survey was disseminated to eight US thalassemia treatment centers in February 2011. The survey was divided into sections ranging from laboratory and clinical practices to emerging transfusion-transmitted diseases.
RESULTS:
The survey response rate was 100%. The total number of transfused patients was 411. One-hundred percent of institutions used leukoreduced blood. No centers routinely provided cytomegalovirus-seronegative red blood cells (RBCs). Half the centers provided irradiated RBCs; only one routinely provided washed RBCs, and none transfused RBCs of defined storage age. Seventy-five percent of centers routinely phenotyped thalassemia patients' RBC antigens; 50% prophylactically matched for Rh and K antigens. The frequency of antibody investigations varied widely, and 25% of centers routinely medicated patients before transfusion.
CONCLUSION:
Eight thalassemia centers in the United States were surveyed to determine the uniformity of transfusion practice. The variability of the results was surprising. Consequently, we performed a literature review and propose an evidence-based protocol for routine transfusion therapy for patients with thalassemia.
AuthorsCheryl Goss, Patricia Giardina, Diana Degtyaryova, Dorothy Kleinert, Sujit Sheth, Melissa Cushing
JournalTransfusion (Transfusion) Vol. 54 Issue 7 Pg. 1773-81 (Jul 2014) ISSN: 1537-2995 [Electronic] United States
PMID24611697 (Publication Type: Journal Article, Review)
Copyright© 2014 AABB.
Topics
  • Blood Preservation (methods, standards)
  • Blood Safety (methods, standards)
  • Data Collection
  • Erythrocyte Transfusion (methods, standards, statistics & numerical data)
  • Evidence-Based Practice (standards)
  • Humans
  • Practice Guidelines as Topic
  • Professional Practice (standards, statistics & numerical data)
  • Surveys and Questionnaires
  • Thalassemia (epidemiology, therapy)
  • United States (epidemiology)

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