Background/Case Studies: A community hospital-based cancer center in a rural region launched an autologous (auto) hematopoietic stem cell transplant (HSCT) program in October, 2021. Increased need for blood products was anticipated while patients awaited engraftment. This study aims to describe blood usage at our center tied to auto HSCT admission from program inception through April, 2024.
Study
Design/Methods: Retrospective review of transfusion records for all auto HSCT recipients from October, 2021 and discharged by April, 2024 was performed. Data recorded included patient diagnosis, transplant admission hemoglobin (Hgb) and platelet (Plt) counts, time to engraftment, length of transplant admission, and quantity of blood components transfused until discharge. Institutional prophylactic transfusion guidelines recommend red blood cells (RBCs) for Hgb less than 7.0 g/dL and Plt transfusion if less than 10,000/µL. Apheresis platelets were given.All RBCs and Plts were irradiated and CMV safe.
Results/Findings: Fifty-three auto HSCT patient records were reviewed. Multiple myeloma was the most common diagnosis (37/53, 69.8%), followed by various B cell non-Hodgkin lymphomas (12/53, 22.6%). Median Hgb and Plt at admission were 10.8 g/dL and 182,000/µL, respectively. Mean time to neutrophil engraftment was 11 days (range 9-14) and 17 days (range 12-27) for Plt. HSCT admissions totaled 829 inpatient days; mean admission length was 14 days (range 12 to 48 days). For RBCs, 37 units were transfused (22.4 inpatient days/unit), representing 0.6% of all RBCs transfused at our center during the study period. For Plts, 99 units were transfused (8.37 inpatient days/unit), representing 2.8% of all Plts transfused at our center during the study period. Fifty auto HSCT patients (94.3%) required RBC and/or Plt transfusion during their admission. Nineteen patients (35.8%) required RBCs, with a maximum of 5 RBCs/patient. All 11 patients with admission Hgb below 10.0 g/dL required RBC transfusion, with relative risk (RR) of transfusion 5.26 compared to those with admission Hgb 10.0 g/dL or greater. For Plts, 49 patients (92.5%) required transfusion, with a mean of 1.87 Plts/patient, median 1 Plt/patient, and maximum of 5 units/patient. Admission Plt less than 140,000/µL did not impart increased risk of Plt transfusion (RR = 0.92). No patients received plasma or cryoprecipitate transfusion. Conclusions: Although transfusion is common during auto HSCT admissions in our facility, each patient adds relatively little burden during a typical course. In our experience, a typical auto HSCT patient requires about 1 apheresis Plt per week after transplant, while RBC transfusion appears concentrated in patients with lower admission Hgb. Based on mean admission length and inpatient days per RBC and Plt transfusion, typical blood costs at our center per auto HSCT is $1,454.17.
