Improving transfusion practice in transfusion dependent thalassaemia patients

The aim of this study was to improve current transfusion practice in transfusiondependent thalassaemia patients by determining whether safe transition from triplewashed red cells (TWRC) to leucodepleted red cells (LDRC), increasing transfusion rates, reducing the use of frusemide and creating uniform practice across patients is possible. In patients receiving regular transfusions (50), triple-washed red blood cells were changed to LDRC, transfusion rates were increased to 5 mL/kg/h (in line with the Cooley’s Foundation guidelines) to a maximum of 300 mL/h and frusemide was ceased. Medical review occurred at completion of the transfusion. Of the 20 patients on TWRC, 18 were transitioned to leucodepleted red cells (90%). Recurrent allergic reactions in 2 patients required re-institution of TWRC. 7 of the 8 patients on regular frusemide ceased this practice with no documented transfusion-related fluid overload. One patient refused. Of the eligible 50 patients, 20 patients (40%) were increased to the maximum transfusion rate of 300 mLs/h; 6 (12%) increased rate but refused to go to the maximum; 9 (18%) refused a change in practice and 15 (30%) were already at the maximum rate. There was only one documented transfusion reaction (palpitations) however this patient was able to tolerate a higher transfusion rate on subsequent transfusions. Thalassemia patients on TWRC were safely transitioned to LDRC. Transfusion rates were safely increased, with a calculated reduction in day-stay bed time of 17.45 h per month. This confirms a guideline of 5 mL/kg/h for transfusion-dependant thalassaemia patients with preserved cardiac function is well tolerated and may be translated to other centres worldwide. 本研究的目的是通过确定是否有可能进行从三洗红细胞（TWRC）到去白细胞红细胞（LDRC）的安全过渡，提高输血速率，减少速尿的使用，并在患者中实施统一规则，从而改进输血依赖型地中海贫血患者中现有的输血实践。在接受定期输血的患者（50例）中，将三洗红细胞改为 LDRC，输血速率提高至5 mL/kg/h（符合库利氏贫血基金会的指引），最高可达到300 mL/h，并停止使用速尿。输血完成后进行体检。在使用TWRC的20例患者中，18例转为去白细胞红细胞（90%）。2例患者产生的复发性过敏反应需要重新输以TWRC。8名定期使用速尿的患者中，7名中止了使用该药物，并且没有输血相关液体超负荷的相关记录。一名病人拒绝。在符合条件的50例患者中，20例（40%）增加至300 mL/h的最大输血速率；6例（12%）输血速率提高但拒绝增加至最大；9例（18%）拒绝做出改变，15例（30%）已经达到了最大速率。只产生一例有记录的输血反应（心悸），但是该患者在随后的输血中能够耐受更高的输血速率。使用TWRC的地中海贫血患者安全转用LDRC。输血速率安全地得到提高，计算出减少的白天卧床时间为每月17.45小时。这证实了5 mL/kg/h的指引在心功能得到保护的输血依赖型地中海贫血患者中有良好的耐受性，可以推广至全球其他中心。