Transfusion Related Complication Clinical Trial
Official title:
Randomized Multicenter Trial of Two Transfusion Strategies for Patient Receiving Chemotherapy for Acute Leukemia or Hematopoietic Stem Cells With Medico-economic Evaluation of Cost Minimization.
Patients with acute hematological disease (acute leukemia, aplastic anemia, hematopoietic
stem cells autologous or allogeneic ...) and hospitalized in an intensive care unit
hematology require compensation of anemia and thrombocytopenia by blood transfusions of red
blood packed cells (RBP) or platelet concentrates (PC).The AFSSAPS (Agence Française de
Sécurité Sanitaire des Produits de Santé) recommendations (2002) specify the need to
transfuse 2 RBP in case of symptomatic anemia usually for a hemoglobin between 6 and 10 g /
dL. These recommendations allow to transfuse a single RBP for very elderly patients or in
cases of associated heart disease (heart failure). A recent development (2012) on
post-transfusion pulmonary edema overload recommends transfusion unit by unit for high risk
patients.
More recently, a Swiss team has historically compared transfusion policies in 2 139 patients
with hematological malignancies. The first group received 2 RBP transfusion in case of
symptomatic anemia or hemoglobin level <6 g / dL. The other group only received 1 RBP at each
transfusion. In total 2212 units in 1548 transfusions were performed and the 1 RBP
transfusion policy has resulted in a 25% decrease in the number of RBP used without any
complication. In a prospective single-center pilot study, we showed that transfusing a single
RBP was possible without increasing the side effects of anemia, without complications and
allow an overall reduction in consumption of red blood cell units.
Several meta-analyzes reported in intensive care or bleeding situations that a restrictive
use of transfusions significantly reduces cardiac events, bleeding, bacterial infections and
mortality. The number of patient to be treated to prevent one death is 33.
The main objective is to demonstrate in a randomized trial that the restrictive strategy
(transfusion of a single unit at each transfusion) is not inferior to the liberal strategy
(transfusion of 2 unit at each transfusion) in terms of severe complication. Transfusion are
performed in case of hemoglobin level <8g/dL.
Key secondary objectives are to reduce the number of RBP used and the cost of hospitalization
with a comparison of complications/mortality in the 2 groups.
n/a
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