Abstract

Background - While patient blood management (PBM) principles are not specific to cancer patients, their application contains the pathophysiological premises that could also benefit this patient population. In this study, we assessed the effects of implementing a PBM bundle for cancer patients in the postoperative period.
Materials and methods - The Azienda USL-IRCCS of Reggio Emilia implemented a two-step PBM bundle for the postoperative period of cancer patients hospitalised in the semi-intensive postoperative (SIPO) ward. Step 1 included seminars and lessons specifically targeting SIPO personnel; Step 2 introduced Points of Care (POCs) for the continuous monitoring of haemoglobin (Radical7, Masimo Corp, Irvine, CA, USA). We conducted 3 audits on 600 cancer patients recruited between 2014 and 2017: Audit 1 on 200 patients before the application of our PBM bundle; Audit 2 after Step 1 on 200 patients; Audit 3 after Step 2 on 200 patients monitored with POCs. Red blood cell (RBC) transfusion appropriateness in the postoperative period was evaluated using the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) recommendations.
Results - RBC transfusion appropriateness in the postoperative period of cancer patients rose from 38% to 75% after seminars, and reached 79% after the introduction of POC. The mean number of RBC units each patient received remained unchanged after training sessions (1.8 units/patient) while the introduction of POCs saw a simultaneous decrease in the number of prescribed units (1.3 units/patient).
Discussion - Our PBM bundle positively impacted RBC transfusion appropriateness in postsurgical cancer patients, both in terms of quality and quantity. A structured PBM programme specifically dedicated to surgical oncology should cover the entire perioperative period and might further improve transfusion appropriateness in these patients. The publication of guidelines on the management of anaemia in surgical oncology should be a priority.

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Authors

Lucia Merolle - Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia

Chiara Marraccini - Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia

Erminia Di Bartolomeo - Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia

Maria T. Montella - Operation Management Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia

Thelma A. Pertinhez - Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia; Department of Medicine and Surgery, University of Parma, Parma, Italy

Roberto Baricchi - Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia

Alessandro Bonini - Transfusion Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia

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