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Author contact: pierluigi.alfieri@unimore.it
HOME BLOOD AND PLATELET TRANSFUSIONS  AS PART OF A DOMICILIARY PROGRAM  OF SUPPORTIVE CARE IN PATIENTS  WITH BLOOD MALIGNA...
<ul><li>University Hospital (1) </li></ul><ul><li>Haematology Ward  </li></ul><ul><li>Transfusion Centre </li></ul><ul><li...
COMMUNITY HEALTH TRUST General practitioners Community nurses On-call doctors AIL HOME CARE TEAM Haematologist Specialist ...
Eligibility criteria for  home care <ul><li>Diagnosis of blood malignancy </li></ul><ul><li>Age > 18 and informed consent ...
Patients’ prognostic classification <ul><li>Terminal phase (life expectancy ≤ 3 months) </li></ul><ul><li>Advanced phase (...
Patients’ operative classification <ul><li>Patients with chronic stable disease on watch-&-wait regimen </li></ul><ul><li>...
<ul><li>347 patients referred to  home care service </li></ul><ul><li>161  patients undergone home transfusions (46.4%) </...
Patients’ characteristics - Age Median age = 75 yrs
Patients’ characteristics - Diagnosis
Patients’ characteristics - Prognosis
Duration of home care and survival DURATION OF HOME CARE (days) Patients deceased: 138 OS < 90 days: 64 pts OS 90-180 days...
No. transfusions per diagnosis (1) 22 6 16 4 HL 77 0 77 5 OTHER CHRONIC ANAEMIAS 32 12 20 3 AA 148 47 101 21 NHL 4 12 22 2...
No. transfusions per diagnosis (2)
No. transfusions per disease status  n=83 n=43 n=26 n=9
No. transfusions per home care cycle 6.5 240 88 152 37 NHL / HL / CLL 18.5 425 32 393 23 Chronic phase 35 642 975 RBC + PC...
<ul><li>Indications for PC transfusions </li></ul><ul><li>Platelet count cut-off: 10.000/  l </li></ul><ul><li>lower in t...
Transfusion products: erythrocytes 0.066 +/- 0.09 billions 0.51 +/- 0.43 billions Leukocyte content 54 +/- 6 59 +/- 10 Hae...
Transfusion products: platelets 7.39 +/- 0.06 7.27 +/- 0.05 pH 2.89 +/- 0.5 x 10 11 2.76 +/- 0.4 x 10 11 Platelet content ...
4 5 6 RBC/PC bags collected at Blood Bank Appropriate storage and transport Pre-transfusion clinical assessment Antiallerg...
Complications and adverse reactions  <ul><li>Not complicated transfusions </li></ul><ul><li>Phone calls during/after trans...
 
Conclusions <ul><li>Home transfusions are a valid option in the effort to increase the accessibility and convenience of ca...
Work in progress… <ul><li>Quality-of-life assessment for home-transfused patients </li></ul><ul><li>Management of night an...
www.ailmodena.it
Acknowledgements <ul><li>Dr. Enzo Favale </li></ul><ul><li>Mrs. Paola Baldanzi </li></ul><ul><li>Dr. Lisa Galli </li></ul>...
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EHA 2008

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Oral presentation at the 13th Congress of the European Hematology Association EHA (Copenhagen, 2008).

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Transcript of "EHA 2008"

  1. 1. Author contact: pierluigi.alfieri@unimore.it
  2. 2. HOME BLOOD AND PLATELET TRANSFUSIONS AS PART OF A DOMICILIARY PROGRAM OF SUPPORTIVE CARE IN PATIENTS WITH BLOOD MALIGNANCIES: AN ITALIAN SINGLE-CENTRE EXPERIENCE Alfieri P, Favale E, De Palma M, Torelli G Simultaneous session, Hall C4, 14 th June Vascular biology, bleeding disorders and transfusion medicine
  3. 3. <ul><li>University Hospital (1) </li></ul><ul><li>Haematology Ward </li></ul><ul><li>Transfusion Centre </li></ul><ul><li>Outpatient Clinic </li></ul><ul><li>BMT Unit </li></ul><ul><li>Day Unit </li></ul>Haematology Services in Modena <ul><li>Community Hospitals (7) </li></ul><ul><li>5 Haematology Day Units </li></ul><ul><li>3 Outpatient Clinics </li></ul>20 km
  4. 4. COMMUNITY HEALTH TRUST General practitioners Community nurses On-call doctors AIL HOME CARE TEAM Haematologist Specialist nurse PATIENT’S HOME Patient Caregiver UNIVERSITY HOSPITAL TRUST Division of Haematology Transfusion Centre Centralised Laboratory Services
  5. 5. Eligibility criteria for home care <ul><li>Diagnosis of blood malignancy </li></ul><ul><li>Age > 18 and informed consent </li></ul><ul><li>No self-sufficiency </li></ul><ul><li>Poor performance status and/or severe immunodeficiency </li></ul><ul><li>Appropriate home logistics </li></ul><ul><li>Caregiver availability and trainability </li></ul><ul><li>(Distance from University Hospital < 20 km) </li></ul>
  6. 6. Patients’ prognostic classification <ul><li>Terminal phase (life expectancy ≤ 3 months) </li></ul><ul><li>Advanced phase (life expectancy ≤ 6 months) </li></ul><ul><li>Chronic phase (life expectancy > 6 months) </li></ul><ul><li>Curable disease (in causal therapy) </li></ul>
  7. 7. Patients’ operative classification <ul><li>Patients with chronic stable disease on watch-&-wait regimen </li></ul><ul><li>Patients with chronic or advanced disease in treatment with oral antineoplastic/cytoreductive agents </li></ul><ul><li>Patients with active disease needing intravenous treatment (blood and platelet transfusions, chemotherapy, antimicrobials, etc.) </li></ul><ul><li>Patients in terminal phase needing haematologic end-of-life care </li></ul>
  8. 8. <ul><li>347 patients referred to home care service </li></ul><ul><li>161 patients undergone home transfusions (46.4%) </li></ul><ul><ul><li>67 patients received both RBC (blood) and PC (platelet) </li></ul></ul><ul><ul><li>86 patients received only RBC </li></ul></ul><ul><ul><li>8 patients received only PC </li></ul></ul><ul><li>Total number of transfusions: 2077 </li></ul><ul><ul><li>RBC: 1407 (68%) </li></ul></ul><ul><ul><li>PC: 670 (32%) </li></ul></ul>Activity report July 1999 - April 2008
  9. 9. Patients’ characteristics - Age Median age = 75 yrs
  10. 10. Patients’ characteristics - Diagnosis
  11. 11. Patients’ characteristics - Prognosis
  12. 12. Duration of home care and survival DURATION OF HOME CARE (days) Patients deceased: 138 OS < 90 days: 64 pts OS 90-180 days: 21 pts OS 180-360 days: 30 pts OS > 360 days: 23 pts Median OS: 195 days 0 90 180 270 360 450 540 630 720 810 900 990 1080 1170 1260
  13. 13. No. transfusions per diagnosis (1) 22 6 16 4 HL 77 0 77 5 OTHER CHRONIC ANAEMIAS 32 12 20 3 AA 148 47 101 21 NHL 4 12 22 23 25 42 No. pts 39 19 20 ALL 70 35 35 CLL 276 79 197 MM 335 78 257 MPD 473 92 381 MDS 605 302 303 AML RBC + PC PC RBC Diagnosis
  14. 14. No. transfusions per diagnosis (2)
  15. 15. No. transfusions per disease status n=83 n=43 n=26 n=9
  16. 16. No. transfusions per home care cycle 6.5 240 88 152 37 NHL / HL / CLL 18.5 425 32 393 23 Chronic phase 35 642 975 RBC + PC 2077 276 335 582 644 RBC + PC 15 183 458 43 Advanced phase Median No. PC RBC No. pts Prognostic group 4 7 28 9 In causal therapy 83 161 22 23 33 46 No. pts 11.5 448 527 Terminal phase 13 670 1407 TOTAL 12.5 79 197 MM 14.5 78 257 MPD 17.5 104 478 MDS / ANAEMIAS 14 321 323 AML / ALL Median No. PC RBC Diagnosis
  17. 17. <ul><li>Indications for PC transfusions </li></ul><ul><li>Platelet count cut-off: 10.000/  l </li></ul><ul><li>lower in the terminal setting and in case of refractoriness </li></ul><ul><li>higher if bleeding and fever </li></ul>Full Blood Count (FBC) + Crossmatch Samples delivered to Laboratory 1 2 FBC results on Blackberry ® device 3 Request forms sent to Blood Bank <ul><li>Indications for RBC transfusions </li></ul><ul><li>Hb levels cut-off: 8 gr/dl </li></ul><ul><li>lower in the terminal setting </li></ul><ul><li>higher in cardiopathic and symptomatic patients </li></ul>
  18. 18. Transfusion products: erythrocytes 0.066 +/- 0.09 billions 0.51 +/- 0.43 billions Leukocyte content 54 +/- 6 59 +/- 10 Haematocrit (%) 57 +/- 10 55 +/- 8 Haemoglobin content (gr) 296 +/- 37 300 +/- 20 Volume (ml) Filtrated erythrocytes (leukodepleted) n=158 Erythrocytes without Buffy-Coat resuspended in SAG (leukoreduced) n=99
  19. 19. Transfusion products: platelets 7.39 +/- 0.06 7.27 +/- 0.05 pH 2.89 +/- 0.5 x 10 11 2.76 +/- 0.4 x 10 11 Platelet content 0.056 +/- 0.03 billions 0.062 +/- 0.04 billions Leukocyte content 337 +/- 24 342 +/- 40 Volume (ml) Multicomponent Apheresis Platelets n=25 Pooled Buffy-Coat Platelets n=556
  20. 20. 4 5 6 RBC/PC bags collected at Blood Bank Appropriate storage and transport Pre-transfusion clinical assessment Antiallergic premedication before PC Bed-assistance for the first 15 minutes … Next patient On-call service in case of emergency 7 Caregiver trained to remove needles, manage catheters and dispose bags
  21. 21. Complications and adverse reactions <ul><li>Not complicated transfusions </li></ul><ul><li>Phone calls during/after transfusion </li></ul><ul><li>111 phone calls (5% of all transfusions) </li></ul><ul><li>Extravasation: 74 cases </li></ul><ul><li>Fever: 17 cases </li></ul><ul><li>Nausea/Vomiting: 11 cases </li></ul><ul><li>Skin rash: 9 cases </li></ul>NUMBER OF TRANSFUSIONS 2077 bags
  22. 23. Conclusions <ul><li>Home transfusions are a valid option in the effort to increase the accessibility and convenience of care in fragile patients with blood malignancies </li></ul><ul><li>Operating models should include any strategy to diminish transfusion-related complications and to optimise time and resources </li></ul><ul><li>In the Italian health system the role of fundraising organisations is nowadays essential to sustain home care projects </li></ul>
  23. 24. Work in progress… <ul><li>Quality-of-life assessment for home-transfused patients </li></ul><ul><li>Management of night and holidays urgent transfusions </li></ul><ul><li>Approval of standardised operating protocols </li></ul><ul><li>Cost comparison between hospital and out-of-hospital transfusions </li></ul>
  24. 25. www.ailmodena.it
  25. 26. Acknowledgements <ul><li>Dr. Enzo Favale </li></ul><ul><li>Mrs. Paola Baldanzi </li></ul><ul><li>Dr. Lisa Galli </li></ul><ul><li>Dr. Mirko Menabue </li></ul><ul><li>Division of Haematology </li></ul><ul><li>Prof. Giuseppe Torelli </li></ul><ul><li>Prof. Roberto Marasca </li></ul><ul><li>Prof. Mario Luppi </li></ul><ul><li>Dr. Giovanna Leonardi </li></ul><ul><li>Dr. Leonardo Ferrara </li></ul><ul><li>Transfusion Centre </li></ul><ul><li>Dr. Marisa De Palma </li></ul><ul><li>Dr. Maria Grazia Baldini </li></ul>Mrs. Sonia Berselli Mr. Corrado Cananiello Mrs. Marilena Dallolio

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