Examination of Transfusion Practice in Cancer Related Anemia in Northern Nevada, A Pilot Study

Abstract

Cancer related anemia may result from chemotherapy and/or radiation therapy related myelosuppression, disease process, hemorrhage, nutritional abnormalities, nephrotoxic interventions or hemolysis. The National Comprehensive Cancer Network (NCCN, 2013) recommends associated supportive transfusion therapy guidelines for symptomatic and asymptomatic patients who lean toward hemoglobin maintenance goals of: 7 to 9 g/dL in asymptomatic patients; 8 to10 g/dL in symptomatic patients; and >10g/dL for patients with associated cardiac history. This study was a retrospective chart review, quantitative evaluation, of the management of cancer related anemia in regards to red blood cell transfusion in the largest hospital in northern Nevada. A representative sample was obtained with the inclusion criterion for this study including: Any patient admitted to the hospital between January 1-March 31, 2013 (defining the `Pre' guideline group) as well as between October 1 and December 31, 2013 (defining the `Post' guideline group), with a cancer related diagnosis who received a transfusion of RBCs during their admission. Data analysis showed that the Pre and Post hemoglobin means (7.6 + 1.2 g/dL Pre versus 7.1+1.1 g/dL Post) were not significantly different although there were a higher overall percentage of transfusions in the Post timeframe (31% Pre versus 43% Post). Also of significance was that the analysis of variable symptoms indicated the Pre data pertaining to shortness of breath, malaise/fatigue/weakness, dizziness, and pallor were shown to be proportionally higher than the Post data. This study established that the transfusion practice within this inpatient population at the largest facility in northern Nevada falls within the recommended evidence based guidelines.