Home transfusion: three decades of practice at a tertiary care hospital
Dora García
Department of Hospital at Home, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorAna Aguilera
Department of Hospital at Home, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorFrancisco Antolín
Department of Preventive Medicine and Public Health, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorJosé-Luis Arroyo
Blood and Tissue Bank of Cantabria, Santa Cruz Hospital, Liencres, Spain
Search for more papers by this authorMiguel Lozano
Department of Hemotherapy and Hemostasis, University Clinic Hospital, IDIBAPS, University of Barcelona, Barcelona, Spain
Search for more papers by this authorPedro Sanroma
Department of Hospital at Home, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorCorresponding Author
Iñigo Romón
Blood Transfusion Department, Marqués de Valdecilla University Hospital, IDIVAL, Santander, Spain
Address reprint requests to: Iñigo Romón, Hospital Universitario Marqués de Valdecilla, Servicio de Transfusión, Pabellón 20, 1 °, Avenida Valdecilla, s/n, 39008 Santander, Spain; e-mail: [email protected].Search for more papers by this authorDora García
Department of Hospital at Home, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorAna Aguilera
Department of Hospital at Home, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorFrancisco Antolín
Department of Preventive Medicine and Public Health, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorJosé-Luis Arroyo
Blood and Tissue Bank of Cantabria, Santa Cruz Hospital, Liencres, Spain
Search for more papers by this authorMiguel Lozano
Department of Hemotherapy and Hemostasis, University Clinic Hospital, IDIBAPS, University of Barcelona, Barcelona, Spain
Search for more papers by this authorPedro Sanroma
Department of Hospital at Home, Marqués de Valdecilla University Hospital, Santander, Spain
Search for more papers by this authorCorresponding Author
Iñigo Romón
Blood Transfusion Department, Marqués de Valdecilla University Hospital, IDIVAL, Santander, Spain
Address reprint requests to: Iñigo Romón, Hospital Universitario Marqués de Valdecilla, Servicio de Transfusión, Pabellón 20, 1 °, Avenida Valdecilla, s/n, 39008 Santander, Spain; e-mail: [email protected].Search for more papers by this authorAbstract
BACKGROUND
Hospital at Home (HH) provides specialized care at the patients’ homes. Keeping patients in familial surroundings can result in better outcomes reducing readmission to hospital, mortality, and costs of care. Home transfusion (HT) can be a key element in HH management but is scarcely deployed due to concerns about safety and cost. We have reviewed our HT practice to assess its feasibility and safety.
STUDY DESIGN AND METHODS
We prospectively reviewed data collected from 1985 to 2015, focusing specially on feasibility and procedural safety, looking for adverse events of transfusion. We also assessed the situation in similar hospitals in Spain with a survey about their practice.
RESULTS
A total of 613 patients received 2260 blood components in 2126 transfusion episodes. A total of 93% patients received fewer than 10 transfusions. Most patients were treated for blood diseases (32%) or cancers (20%). The rate of adverse effects was 2.68% and decreased significantly with time. Fever was the most common adverse reaction. Patients who received transfusion of more than one blood product in a day were at higher risk of adverse events. No errors or near-miss events were detected, and no patient had to be readmitted to hospital for this cause. The survey on HT practices in similar hospitals showed great variation in practice.
CONCLUSION
HT is feasible, sustainable, and safe, when performed on selected patients by dedicated HH units with well-trained staff, under specific protocols.
CONFLICT OF INTEREST
The authors have disclosed no conflicts of interest.
Supporting Information
| Filename | Description |
|---|---|
| trf14816-sup-0001-suppinfo01.docx22.2 KB |
Table S1. Severity and imputability scales for adverse reactions of transfusion.1,2,3 |
| trf14816-sup-0002-suppinfo02.docx22.9 KB |
Table S2. Definition of adverse reactions of transfusion.1,2,3 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Cherkasky M. The Montefiore Hospital home care program. Am J Public Health Nations Health 1949; 39: 163-6.
- 2Bluestone EM. The principles and practice of home care. J Am Med Assoc 1954; 155: 1379-82.
- 3Medicare. What's home health care & what should I expect? [Internet]. Washington (DC): Medicare.gov [cited 2018 Mar 20]. Available from: https://www.medicare.gov/what-medicare-covers/home-health-care/home-health-care-what-is-it-what-to-expect.html.
- 4Shepperd S, Doll H, Angus RM, et al. Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data. CMAJ 2009; 180: 175-82.
- 5Valdivieso Martínez B, Bahamontes Mulió A, Soriano Melchor E. Introducción, justificación, misión y valores de la hospitalización a domicilio. In: P Sanroma Mendizábal, I Sampedro García, CR González Fernández, MT Baños Canales, editors. Hospitalización domiciliaria: recomendaciones clínicas y procedimientos. Santander: Fundación Marqués de Valdecilla; 2010. p. 7-14.
- 6Caplan GA, Sulaiman NS, Mangin DA, et al. A meta-analysis of “hospital in the home.” Med J Aust 2012; 197: 512-9.
- 7Dreesen M, Foulon V, Spriet I, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr 2013; 32: 16-26.
- 8Vashi PG, Virginkar N, Popiel B, et al. Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC Infect Dis 2017; 17: 372.
- 9Home healthcare overview [Internet]. Baltimore (MD): Johns Hopkins Medicine [cited 2018 Mar 20]. Available from: https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/home_health_hospice_and_elder_care/home_healthcare_overview_85,P00611.
- 10Healthcare at Home [Internet]. Albuquerque (NM): Presbyterian Healthcare Services; 2018 [cited 2018 Mar 20]. Available from: https://www.phs.org/doctors-services/services-centers/Pages/home-healthcare.aspx.
- 11Benson K. Blood transfusions in the home sweet home: how to avoid a sour outcome. Cancer Control 1997; 4: 364-7.
- 12Benson K. Home is where the heart is: do blood transfusions belong there too? Transfus Med Rev 2006; 20: 218-29.
- 13Ademokun A, Kaznica S, Deas S. Home blood transfusion: a necessary service development. Transfus Med 2005; 15: 219-22.
- 14Benson K, Popovsky MA, Hines D, et al. Nationwide survey of home transfusion practices. Transfusion 1998; 38: 90-6.
- 15van Gammeren AJ, Haneveer MM. A nationwide survey on out-of-hospital transfusions in the Netherlands. Transfus Med 2017; 27: 218-21.
- 16Green J, Pirie L. Framework for the development of an out of acute hospital blood transfusion service [Internet]. London: NHS Blood and Transplant; 2012 (amended 2013) [cited 2018 Mar 20]. Available from: http://hospital.blood.co.uk/media/27199/home_tx_framework_post-shot-2013.pdf.
- 17 Nova Scotia Provincial Blood Coordinating Program. Guidelines for home transfusion [Internet]. Halifax: NovaScotia.ca; 2014 [cited 2018 Mar 20]. Available from: https://novascotia.ca/dhw/nspbcp/docs/Home-Transfusion-Guideline.pdf.
- 18 New York State Council on Human Blood and Transfusion Services. Elective out-of-hospital transfusion: recommended criteria and guidelines for transfusion of blood components [Internet]. New York: New York State Department of Health; 2012 [cited 2018 Mar 20]. Available from: https://www.wadsworth.org/sites/default/files/WebDoc/1721604823/outofhosptx0812final.pdf.
- 19Maynard K. Administration of blood components. In: MK Fung, BJ Grossman, CD Hillyer, CM Westhoff, editors. Technical manual. Bethesda (MD): AABB; 2014. p. 545-57.
- 20 Standards for blood banks and transfusion services. 29th ed. Bethesda (MD): AABB; 2014.
- 21Miller PC. Home blood component therapy—an alternative. NITA 1986; 9: 213-7.
- 22Pluth NM. A home care transfusion program. Oncol Nurs Forum 1987; 14: 43-6.
- 23Crocker KS, Coker MH. Initiation of a home hemotherapy program using a primary nursing model. J Intraven Nurs 1990; 13: 13-9.
- 24 Out of hospital transfusion therapy. Bethesda (MD): AABB; 1994.
- 25Thompson HW, McKelvey J. Home blood transfusion therapy: a home health agency's 5-year experience. Transfusion 1995; 35: 453.
- 26Craig JIO, Milligan P, Cairns J, et al. Nurse practitioner support for transfusion in patients with haematological disorders in hospital and at home. Transfus Med 1999; 9: 31-6.
- 27Fridey JL. Practical aspects of out-of-hospital transfusion. Am J Clin Pathol 1997; 107: S64-71.
- 28Brook L, Vickers J, Pizer B. Home platelet transfusion in pediatric oncology terminal care. Med Pediatr Oncol 2003; 40: 249-51.
- 29Isaia G, Tibaldi V, Astengo M, et al. Home management of hematological patients requiring hospital admission. Arch Gerontol Geriatr 2010; 51: 309-11.
- 30Niscola P, Tendas A, Giovannini M, et al. Transfusions at home in patients with myelodysplastic syndromes. Leuk Res 2012; 36: 684-8.
- 31Ritchie EK. Blood simple: transfusion at home for patients with MDS. Leuk Res 2012; 36: 675-6.
- 32Tamayo Fernández B, Sanroma Mendizábal P, García Berasaluce A, Cerejo Quintero MJ, Rio Vizoso M, Lama Rincón JM, et al. Transfusión domiciliaria de hemoderivados. In: P Sanroma Mendizábal, I Sampedro García, CR González Fernández, MT Baños Canales, editors. Hospitalización domiciliaria: recomendaciones clínicas y procedimientos. Santander: Fundación Marqués de Valdecilla; 2010.
- 33 Comité Cientifíco de Seguridad Transfusional. Transfusión extrahospitalaria [Internet]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad [cited 2018 Mar 20]. Available from: http://www.msssi.gob.es/profesionales/saludPublica/medicinaTransfusional/acuerdos/docs/Transfusion_Extrahospitalaria.pdf.
- 34Fridey JL. General principles of home blood transfusion [Internet]. Alphen aan den Rijn: UpToDate; 2017 [cited 2018 Mar 20]. Available from: https://www.uptodate.com/contents/general-principles-of-home-blood-transfusion.
- 35 Guide to the preparation, use, and quality assurance of blood components. 19th ed. Strasbourg: Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM); 2017.
- 36Real Decreto 1088/2005, de 16 de septiembre, por el que se establecen los requisitos técnicos y condiciones mínimas de la hemodonación y de los centros y servicios de transfusión. Ministerio de Sanidad y Consumo. Boletín Oficial Del Estado 20 Septiembre 2005; 2005: 31288-304.
- 37Orden SCO/322/2007, de 9 de febrero, por la que se establecen los requisitos de trazabilidad y de notificación de reacciones y efectos adversos graves de la sangre y de los componentes sanguíneos. Boletín Oficial Del Estado 17 De Febrero De 2007. 2007; 2007: 7010-6.
- 38Insunza A, Romon I, Gonzalez-Ponte ML, et al. Implementation of a strategy to prevent TRALI in a regional blood centre. Transfus Med 2004; 14: 157-64.
- 39Treleaven J, Gennery A, Marsh J, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Br J Haematol 2011; 152: 35-51.
- 40Tamayo B, Fonquernie MT, García, et al. Experiencia de 25 años sobre transfusión domiciliaria de hemoderivados en una unidad de hospitalización a domicilio XXI Meeting of the Spanish Society of Blood Transfusion and Cellular Therapy. Málaga 2010.
- 41 PH Bolton-Maggs, editor. Annual SHOT report 2016 [Internet]. Manchester: The SHOT Office; 2017 [cited 2018 Mar 20]. Available from: https://www.shotuk.org/wp-content/uploads/myimages/SHOT-Report-2016_web_11th-July.pdf.
- 42Donegan R, Wright A, Bobbitt L, et al. Overnight transfusions in New Zealand hospitals: potential risk to patients. N Z Med J 2016; 129: 30-7.
- 43Savage WJ. Transfusion reactions. Hematol Oncol Clin North Am 2016; 30: 619-34.
- 44 PH Bolton-Maggs, editor. Annual SHOT report 2015 [Internet]. Manchester: The SHOT Office; 2016 [cited 2018 Mar 20]. Available from: https://www.shotuk.org/wp-content/uploads/myimages/SHOT-2015-Annual-Report-Web-Edition-Final-bookmarked-1.pdf.
- 45Liumbruno GM, Catalano L, Piccinini V, et al. Reduction of the risk of bacterial contamination of blood components through diversion of the first part of the donation of blood and blood components. Blood Transfus 2009; 7: 86-93.
- 46Klein HG, Anderson D, Bernardi MJ, et al. Pathogen inactivation: making decisions about new technologies. Report of a consensus conference. Transfusion 2007; 47: 2338-47.
- 47Vamvakas EC. Relative safety of pooled whole blood-derived versus single-donor (apheresis) platelets in the United States: a systematic review of disparate risks. Transfusion 2009; 49: 2743-58.
- 48Muylle L, Peetermans ME. Effect of prestorage leukocyte removal on the cytokine levels in stored platelet concentrates. Vox Sang 1994; 66: 14-7.
- 49Heddle NM, Klama L, Singer J, et al. The role of the plasma from platelet concentrates in transfusion reactions. N Engl J Med 1994; 331: 625-8.
- 50Silliman CC, Ambruso DR, Boshkov LK. Transfusion-related acute lung injury. Blood 2005; 105: 2266-73.
- 51Chapman CE, Stainsby D, Jones H, et al. Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion 2009; 49: 440-52.
- 52Hemovigilancia Año 2015 [Internet]. ••••••••: Ministerio de Sanidad, Consumo y Bienestar Social, Madrid, Spain; 2018 [cited 2018 Mar 20]. Available from: https://www.msssi.gob.es/profesionales/saludPublica/medicinaTransfusional/hemovigilancia/docs/Informe2015.pdf.
- 53Verdú-Belmar JJ, Verdú-Verdú J, Soler-Martínez S. [Active hemosurveillance: a system that evaluates those post-transfusional adverse effects that are not detected by the conventional hemosurveillance system]. Med Clin (Barc) 2006; 127: 516.
- 54Lieberman L, Maskens C, Cserti-Gazdewich C, et al. A retrospective review of patient factors, transfusion practices, and outcomes in patients with transfusion-associated circulatory overload. Transfus Med Rev 2013; 27: 206-12.
- 55Agnihotri N, Agnihotri A. Active hemovigilance significantly improves reporting of acute non-infectious adverse reactions to blood transfusion. Indian J Hematol Blood Transfus 2016; 32: 335-42.
Citing Literature
