Differences among hemoglobin thresholds for red blood cell transfusions in patients with hematological diseases in teach
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ORIGINAL ARTICLE
Differences among hemoglobin thresholds for red blood cell transfusions in patients with hematological diseases in teaching hospitals: a real world data in Japan Akihiko Yokohama1,2 · Yoshiki Okuyama3 · Yasunori Ueda4 · Masumi Itoh5 · Shin‑ichiro Fujiwara2,6 · Yuichi Hasegawa2,7 · Kazuhiro Nagai8 · Kimika Arakawa9 · Koji Miyazaki10 · Masanori Makita11 · Mai Watanabe12 · Kazuhiko Ikeda13 · Asashi Tanaka2,14 · Keizo Fujino2,15 · Mayumi Matsumoto2,16 · Shigeyoshi Makino2,17 · Shuichi Kino2,18 · Akihiro Takeshita2,19 · Kazuo Muroi2,20 Received: 7 April 2020 / Revised: 8 June 2020 / Accepted: 23 June 2020 © Japanese Society of Hematology 2020
Abstract A hemoglobin (Hb) threshold level of 7 g/dL has been proposed for red blood cell (RBC) transfusion in patients with chronic anemia in the Japanese guideline since 2005. However, Hb thresholds for hematological diseases in clinical practice and factors responsible for higher Hb thresholds remain unclear. Hb thresholds were collected for patients with hematological diseases from 32 Japanese teaching hospitals. Uni- and multivariate analyses were used to analyze relationships between Hb threshold level and various patient and hospital factors. In total, 4996 units of RBC were transfused to 1054 patients with hematological diseases in 2421 transfusions. Median age was 68 years. Myelodysplastic syndrome was the most frequent diagnosis. Overall median Hb threshold level was 6.9 g/dL. Multivariate linear regression analysis detected the following variables associated with Hb threshold level: hospital; cardiovascular disease; symptomatic anemia; and hematopoietic stem cell transplantation. Hospital was the most significant factor. Collectively, median Hb threshold level in clinical practice in Japan was similar to the guidelines. Higher Hb threshold level depended on the hospitals at which the transfusions were performed as well as patient condition. Educational approaches directed toward hospitals may be useful to promote transfusion guidelines. Keywords Red blood cell transfusion · Hemoglobin threshold level · Hematological disease · Guideline
Introduction Hemoglobin (Hb) threshold level is used as an indicator for the initiation of red blood cell (RBC) transfusion, based on evidence from many randomized clinical trials (RCTs) [1–16]. In those trials, RBC transfusion strategy using a lower Hb threshold level (restrictive, Hb 7 or 8 g/dL) was compared to that using a higher Hb level (liberal, 9 or 10 g/ dL) in different clinical settings such as hip surgery, cardiac surgery, septic shock and gastrointestinal bleeding, applying Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12185-020-02937-3) contains supplementary material, which is available to authorized users. * Akihiko Yokohama ayoko@gunma‑u.ac.jp Extended author information available on the last page of the article
various end points. In most studies, clinical outcomes with a restrictive Hb threshold level were similar or superior to those of liberal
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