Home blood transfusion therapy: a home health agency's 5‐year experience

To the Editor: Health care services are being performed in the home with an increasing frequency in the United States. Procedures such as blood transfusion, which once were performed only on patients in the hospital or at the hospital on an outpatient basis, have been reevaluated and are now available as home care services. Home blood transfusion therapy (HB'IT) has been used for a number of years in hemophiliac patients for the administration of factor concentrates. ' Patients requiring other blood components such as red cells and platelets are now considered candidates for HBTT. Such patients include those with cancer and human immunodeficiency virus infection who require chronic transfusion Our home health agency addressed medical, legal, and economic factors with patient safety as the primary concern before implementing an HBTT pr0gram.4. ~ A policy and procedures manual, consent and order forms, and patient education material were developed and reviewed for safety before starting HBTT in December 1987. The purpose of this report is to review 5 years of patient data and to demonstrate, on the basis of our experience, that HBTT is a safe alternative for some patients requiring transfusions. Strict criteria were established for acceptance of patients into the HB'IT program. These included: 1) alert, cooperative, and responsive patients without uncontrolled hypertension, unstable angina, or congestive heart failure; 2) history of allogeneic blood transfusion without significant reaction; 3) requirement for no more than 3 units of blood or components during a single transfusion encounter; 4) physician visit during the 2 weeks before anticipated transfusion and physician availability via telephone during the transfusion; 5) adequate venous access; 6) nonemergent situation (i.e., patient can wait 24 to 48 hours for transfusion); and 7) compatible blood available for transfusion. Red cell transfusions were given for symptomatic anemia, generally when the hemoglobin was 18.0 g per dL. Platelets were transfused to nonbleeding patients with a platelet count of 520 x lo9 per L (20,000/&). We compiled patient population data throughout the course of HBTT; routine review was performed on a quarterly basis by a transfusion review committee. Red cells were white cell reduced, either at the bedside (808 units) or shortly after collection (224 units). Platelets were white cell reduced by bedside filtration and were either single-donor apheresis platelets (1 unit) or pooled concentrates (273 total units, usually transfused in pools of 10). Assessment of patients, documenting pertinent clinical data including laboratory information, was performed before each transfusion. A pretransfusion hemoglobin or hematocrit was obtained before transfusion of red cells and within 72 hours after transfusion. For platelet transfusions, a pretransfusion platelet count was performed and a posttransfusion count was requested at 24 hours. Successful outcome of a red cell transfusion was defined as an increase of approximately 1 g per dL in hemoglobin or 3 percent in hematocrit per unit transfused. Successful outcome of platelet transfusion was defined as a posttransfusion platelet increment of at least 30 x 109 per L. AIDS and oncology patients (n = 3 10) were given 1032 units of red cells. Twenty-eight platelet transfusions, consisting of 273 random-donor platelet concentrates and 1 apheresis platelet component, were administered. Table 1 shows the activity of HBTT during this interval. No adverse effects, including febrile or allergic transfusion reactions, were seen with any of Table 1. HBl7activii-y by year, 1988 through 7992