Background/Case Studies: Home hospitalization provides specialized care while keeping patients in their familiar environment. There is a current interest in decentralizing hospital care to improve patient convenience, minimize costs to the health service, and to prevent nosocomial infections, especially after the COVID-19 pandemia. Although home transfusion (HT) is an increasingly used strategy, safety concerns may be a perceived barrier to its implementation. Therefore, the objective of this study was to assess HT feasibility and safety.
Study
Design/Methods: A HT multidisciplinary protocol was implemented in our hospital during the first COVID-19 pandemic wave and it has been consolidated in subsequent years. To be eligible for HT, all cases were previously evaluated by Blood Bank and Home Hospitalization teams. Inclusion criteria were: informed consent signed, stable patients, an available involved caregiver, patient home within less than 30 min from hospital, previous transfusion history without adverse transfusion reactions or erythrocyte alloantibodies. Some selected cases that did not meet all criteria, were evaluated multidisciplinary taking into account the risk-benefit assessment and quality of life. The nursing staff stayed with the patient during the first 30 minutes of the red blood cell (RBC) infusion and until the end of platelet transfusion (PLT). The caregiver was trained to identify and report alarm signs. We prospectively reviewed data collected from March 2020 to March 2023. We evaluated demographics, clinical and transfusion history, reason for the request, and transfusion adverse side effects.
Results/Findings: During the inclusion period we received 290 HT requests. In 55 cases (18.9%), the transfusion was not performed. The main reasons for unacceptance were: unmet inclusion criteria (n=23; 41.8%) and patient finally transferred to a hospital center (n=8; 14.5%). 85 adult patients received 235 transfusions, 401 RBC units, and 8 PLT concentrates. Median patient age was 88 years-old (range: 22-99 years-old) and presented more than 3 points in the Comorbidity Charlson Index in 97,3% of the cases. Other characteristics of the transfused patients are shown in Table 1. 29 patients (34.1%) received more than one transfusion and in most cases (63.3%) 2 RBC units were administrated per day. Given the high risk of TACO, with more than 2 risk factors in 61.1% of the studied population, in 210 (83.3%) transfusions, preventive diuretic administration was considered. Regarding adverse reaction incidences, a single potential side effect was made aware, which was the worsening of a previous heart failure symptomatology in a palliative care patient. Conclusions: Home transfusion is feasible and safe even in frail complex patients if performed on selected cases and under specific multidisciplinary protocols and assessment.
Importance of research: Blood transfusions may be associated with increased risk of morbidity and mortality. This risk may be increased in a home setting due to the distance from an acute care facility. Although several thousand blood units are transfused at home yearly, information about safety is scarce. This study highlights that home transfusion is safe even in a frail complex patient setting.
