High red blood cell (RBC) and platelet transfusion burden in patients with myelodysplastic syndromes (MDS).

Abstract

Aim: Despite transfusion being a cornerstone ofMDS management, the evidence base to inform guidelines remains weak, and real-world data on outpatient transfusion practice are lacking. We aimed to describe current practice regarding transfusion of RBCs and platelets, including frequency, transfusion triggers, adjunctive medications and transfusion-related outcomes. Method(s): Retrospective cohort study of all patients with MDS/chronic myelomonocytic leukaemia (CMML) admitted at Monash Health from August 2016 to July 2018, using hospital medical record data. Result(s): One hundred eighty MDS/CMML patients (61% male, median age 78y) were identified with a total of 809 admissions, including 513 dayadmissions, of which 414 (81%) involved RBC/platelet transfusion. Transfused patients were more likely to be receiving azacitidine (32% vs 12%, P=0.002). One hundred two patients (56%) received 707 RBC units during 386 outpatient episodes. Table1 shows transfusion interval, pre-transfusion counts and post-transfusion increments. Erythropoiesis-stimulating agents [ESAs]) were prescribed in <10% of transfused patients (table 2). The RBC-transfused group had higher rates of fluid overload/acute cardiac failure (19% vs 6%, P = 0.017) despite similar baseline cardiac failure history. There was no difference in cardiac ischaemia. No further transfusion reactions were documented. Thirty-five patients (19%) received 107 bags of platelets in 88 outpatient transfusions (Table 1). Approximately one third of patients receiving outpatient platelet transfusions were also receiving tranexamic acid (TXA; table 2). Sixteen bleeding episodes occurred (11 gastrointestinal, 1 intracranial and 4 other), which were not predicted by admission platelet counts or history of TXA use/ platelet transfusions (table 3). Conclusion(s): In a cohort of 180 MDS/CMML patients, we found a high transfusion burden, with 81% of admissions involving transfusion. Despite a restrictive RBC transfusion strategy, fluid overload/cardiac failure was common. Platelet increments post-transfusion were minimal, and although bleeding rates were low, 1 intracranial haemorrhage was reported. Prospective trials are required to investigate optimal transfusion practice and patient outcomes, including quality-of-life. (Table Presented) .