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Binder AF, Hossain A, Doshi R, Vivero A, Gonzalez KM, Gentsch A, Wilde L, Rising KL. Patient and caregiver perceptions of the possibility of home blood transfusions. Transfusion 2024; 64:483-492. [PMID: 38263774 DOI: 10.1111/trf.17728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Patients with hematologic malignancies (HM) often develop transfusion dependence. The patient and caregiver burdens associated with the need for frequent transfusions are high. Home blood transfusions has the potential to reduce these burdens, but is not widely practiced in the United States. We designed a qualitative study to evaluate the patient and caregiver perceptions of the potential for a home blood transfusion program. STUDY DESIGN AND METHODS Eligible patients included Adult (≥18 years) patients who were English speaking and met the definition for transfusion dependence within 3 months of study enrollment. We identified and interviewed eligible participants (patients and caregivers), using a semi-structured interview guide to elicit patient perceptions of the acceptability, barriers, and benefits related to home blood product transfusions. Interviews were audio recorded and transcribed. Results were imported into NVivo 12 (version 12; QSR International, Burlington, VT) for coding and analysis. RESULTS We recruited participants until we reached thematic saturation, which occurred at 29 participants (20 patients, 9 caregivers). Among the 20 patient participants, nine had MDS (45%) and 11 had acute leukemia (55%). Most of the patients (60%) reported getting one transfusion per week. Four themes emerged when the participants discussed their perception regarding the potential of a home blood transfusion program: (1) current in-person experience, (2) caregiver burden, (3) perceptions of home blood transfusions, and (4) interest in participating in a home blood transfusion program. CONCLUSION The concept of home blood transfusions was well received and further research to study its implementation is warranted.
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Affiliation(s)
- Adam F Binder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alavi Hossain
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Riyana Doshi
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Angelica Vivero
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Karla Martin Gonzalez
- Department of Emergency Medicine, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexzandra Gentsch
- Department of Emergency Medicine, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lindsay Wilde
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Azer A, Panayotova GG, Kong K, Hakakian D, Sheikh F, Gorman E, Sutherland A, Tafesh Z, Horng H, Guarrera JV, Glass NE. Clinical Application of Thromboelastography in Patients With Cirrhosis: A Single Center Experience. J Surg Res 2023; 287:142-148. [PMID: 36933545 DOI: 10.1016/j.jss.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Thromboelastography (TEG) is a functional test of coagulation used to guide transfusions. Despite literature supporting its utility, its use remains limited to select populations. In patients with cirrhosis, conventional coagulation tests are notoriously inaccurate, and TEG may be a better measure of coagulopathy. We aimed to assess the utilization of TEG in patients with cirrhosis to steward blood transfusions in this high-risk group. METHODS A single-center retrospective chart review of all patients ≥18 y old with a diagnosis of liver cirrhosis who had TEG results documented in the electronic medical record from January 1 to November 1, 2021. RESULTS There were 277 TEG results on 89 patients with cirrhosis. Overall, 91% of the TEGs performed were associated with a clinical indication for transfusion. However, of the patients who were transfused, abnormal TEG values, including elevated R time and reduced maximum amplitude, did not correspond to transfusion of indicated blood products (fresh frozen plasma and platelets). A reduction in alpha angle showed a statistically significant association with transfusion of cryoprecipitate (P < 0.05). When assessing conventional coagulation tests, abnormal values were not significantly associated with transfusion (P = 0.07). CONCLUSIONS Despite TEG suggesting that transfusions could be avoided in many cirrhotic patients, patients are still being transfused platelets and fresh frozen plasma in the absence of evidence of coagulopathy on TEG. Our finding suggests the need for education about appropriate utilization of TEG. More research is needed to understand the role of these tests to guide transfusion practices in patients with cirrhosis.
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Affiliation(s)
- Amanda Azer
- Division of Trauma and Critical Care Surgery, Department of Surgery, Rutgers NJMS, Newark, New Jersey
| | - Guergana G Panayotova
- Division of Transplant and HPB Surgery, Department of Surgery, Rutgers, NJMS, Newark, New Jersey
| | - Karen Kong
- Division of Trauma and Critical Care Surgery, Department of Surgery, Rutgers NJMS, Newark, New Jersey
| | - Daniel Hakakian
- Division of Trauma and Critical Care Surgery, Department of Surgery, Rutgers NJMS, Newark, New Jersey
| | - Fariha Sheikh
- Division of Trauma and Critical Care Surgery, Department of Surgery, Rutgers NJMS, Newark, New Jersey
| | - Elizabeth Gorman
- Division of Trauma and Critical Care Surgery, Department of Surgery, Rutgers NJMS, Newark, New Jersey
| | | | - Zaid Tafesh
- Department of Medicine, Rutgers NJMS, Newark, New Jersey
| | - Helen Horng
- University Hospital, Pharmacy, Newark, New Jersey
| | - James V Guarrera
- Division of Transplant and HPB Surgery, Department of Surgery, Rutgers, NJMS, Newark, New Jersey
| | - Nina E Glass
- Division of Trauma and Critical Care Surgery, Department of Surgery, Rutgers NJMS, Newark, New Jersey.
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Miyashita N, Ohashi K, Fujita M, Hosoda T, Kawasaki Y, Takimoto M, Onozawa M. Prognostic factors in patients in the terminal phase of haematological malignancies who are receiving home medical care. Br J Haematol 2022; 201:290-301. [PMID: 36572123 DOI: 10.1111/bjh.18623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022]
Abstract
Although there are many prognostic models for patients in the terminal phase of solid tumours, a reliable prognostic scoring system in patients in the terminal phase of haematological malignancies (HM) has not been established. We retrospectively evaluated 180 patients in the terminal phase of HM who were receiving home medical care (HMC). Multivariate analyses revealed that clinician's estimate, consciousness, loss of appetite, dyspnoea, neutrophil count, lymphocyte count, and lactate dehydrogenase were associated with overall survival (OS). Based on this result, we developed a novel prognostic scoring system, the Japan palliative haematological oncology prognostic estimates, in which four risk groups were shown to clearly differ in survival (p < 0.001): a low-risk group (n = 41, median OS of 434 days), an intermediate-low-risk group (n = 80, median OS of 112 days), an intermediate-high-risk group (n = 38, median OS of 31.5 days), and a high-risk group (n = 21, median OS of 10 days). This is the first investigation of prognostic factors that influence the OS of patients in the terminal phase of HM who are receiving HMC. Providing patients with reliable information about their prognosis is important for them to consider how to spend their remaining life.
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Affiliation(s)
- Naohiro Miyashita
- Department of Hematology HOME CARE CLINIC N‐CONCEPT Sapporo Japan
- NPO Hemato‐Homecare Network Tokyo Japan
| | - Kota Ohashi
- NPO Hemato‐Homecare Network Tokyo Japan
- TOTUS Home Care Clinic Tokyo Japan
| | - Mariko Fujita
- Medical Home Care Center, Tenri Hospital Tenri Japan
| | - Toru Hosoda
- NPO Hemato‐Homecare Network Tokyo Japan
- Hamorebi Clinic Kamagaya Japan
| | - Yasufumi Kawasaki
- NPO Hemato‐Homecare Network Tokyo Japan
- Kaedenokaze Medical Clinic Tokyo Japan
| | - Madoka Takimoto
- NPO Hemato‐Homecare Network Tokyo Japan
- Kawasaki Nanafuku Clinic Kawasaki Japan
| | - Masahiro Onozawa
- Department of Hematology Hokkaido University Hospital Sapporo Japan
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Rodríguez Corte J, Candal‐Pedreira C, Ruano‐Ravina A, Pérez‐Ríos M, Rivero‐de‐Aguilar A, López García M, Hermida Porto L, Varela‐Lema L. Home-based blood transfusion therapy: A systematic review. Br J Haematol 2022; 199:496-506. [PMID: 35778372 PMCID: PMC9796283 DOI: 10.1111/bjh.18344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 01/28/2023]
Abstract
Home care is a healthcare alternative to hospitalisation. Different types of procedures are performed at home care services, such as home transfusion of blood products. However, home blood transfusion is not fully implemented and there is a great lack of knowledge about it. The aims of this study were thus to assess the safety and effectiveness of home blood transfusions and patient acceptance and satisfaction. A systematic literature review was conducted in the main biomedical databases. We included all studies that covered patients who had received a home blood transfusion, regardless of their baseline diagnosis. The literature search yielded 290 studies, 14 of which were included in this study as they met the predefined criteria. The main patient profile of a home-transfusion recipient was a person with anaemia associated with other diseases. Overall incidence of severe adverse events was 0.05%. No studies evaluated the effectiveness of home versus hospital transfusions. One study showed that 51% of patients would be willing to receive home transfusions. Home blood transfusion appears to be a feasible, safe, and well-accepted procedure. Existing studies are of low quality, however, and this is an important limitation when it comes to drawing definitive benefit-risk conclusions.
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Affiliation(s)
- Jesús Rodríguez Corte
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain
| | - Cristina Candal‐Pedreira
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain
| | - Alberto Ruano‐Ravina
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
| | - Mónica Pérez‐Ríos
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
| | - Alejandro Rivero‐de‐Aguilar
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Neurology ServiceUniversity Hospital of the Canary IslandsTenerifeSpain
| | - Marisa López García
- Galician Health ServiceThe Galician Blood and Organ and Donation Agency (ADO)Santiago de CompostelaSpain
| | - Leticia Hermida Porto
- Galician Health Service, Home Hospitalisation Unit (HADO)A Coruña University Hospital ComplexSantiago de CompostelaSpain
| | - Leonor Varela‐Lema
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
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Gutwein O, Herzog Tzarfati K, Apel A, Rahimi‐Levene N, Michaeli H, Barki‐Harrington L, Koren‐Michowitz M. Haematological patients' perception of home transfusions: Effect of the
COVID
‐19 pandemic. Vox Sang 2022; 117:1195-1201. [DOI: 10.1111/vox.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Odit Gutwein
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | | | - Arie Apel
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | - Naomi Rahimi‐Levene
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | - Hani Michaeli
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | - Liza Barki‐Harrington
- Department of Human Biology, Faculty of Natural Sciences University of Haifa Haifa Israel
| | - Maya Koren‐Michowitz
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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