Rational use of blood and blood components in hematology and oncology

Objective: In order to minimize bleeding complications, virus transmission, alloimmunization or graft-versus-host disease, a more restrictive transfus ion policy may be advantageous. Patients and Methods: In our study we evalu ated the transfusion of blood and blood components and the clinical course of 41 patients with hematologic malignancy or solid tumors during hospitali zation following transplantation (TX). The threshold for platelets was set at <20,000/mu l. Erythrocyte transfusion was found to be indicated at hemog lobin (Hb) values below 8.0 g/dl in hemodynamically/cardiopulmonary unstabl e patients as severe coagulation disorders implicated the replacement of fr esh frozen plasma. Leukocyte-reduced, bedside-filtrated, and radiated (30 G y) platelets (non-HLA-typed) and red blood cells (RBCs) were transfused. In the case of CMV positivity of the recipient before TX and/or donor, the CM V state of the transfused products was not regarded. Statistical analysis w as performed using the chi(2) assay. Results: Significantly more single-don or concentrates collected by blood separators from Fresenius (AS 104, ASTEC 204) and from Cobe (Spectra LRS) were transfused at group II (allogenic tr ansplantation) patients (17.13 +/- 18.59) compared with autologously transp lanted (group I) patients (4.77 +/- 5.01), whereas no difference could be e valuated in the replacement of RBCs, and fresh frozen plasma. The duration of hospitalization also differed significantly (group I: 36 +/- 20 days; gr oup II: 50 +/- 23 days). Minor bleedings did occur more or less often in on e of each group. No major bleedings were registered. Graft-versus-host dise ases could be objected in 8 allogenically transplanted patients. 10/41 pati ents probably died due to complications associated with the underlying dise ase and therapy. Conclusion: In view of the socioeconomic interests and bei ng also aware that the potential of blood donors is limited, a more restric tive transfusion policy, if clinically justified, may be indicated even in high-risk patients.