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2150-12-31
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BLOOD TRANSFUSION IN THE CARE OF PATIENTS WITH VISCERAL LEISHMANIASIS: A REVIEW OF PRACTICES IN THERAPEUTIC EFFICACY STUDIES
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Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG Brazil
Médecins Sans Frontiéres. Plantage Middenlaan, Amsterdam, Netherlands.
Institute of Endemic Diseases. University of Khartoum. Khartoum, Sudan.
Drugs for Neglected Diseases initiative. Geneva, Switzerland.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG Brazil
Médecins Sans Frontiéres. Plantage Middenlaan, Amsterdam, Netherlands.
Institute of Endemic Diseases. University of Khartoum. Khartoum, Sudan.
Drugs for Neglected Diseases initiative. Geneva, Switzerland.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Infectious Diseases Data Observatory. Oxford, UK/Centre for Tropical Medicine and Global Health. Nuffield Department of Medicine. University of Oxford. Oxford, UK.
Abstract
Blood transfusion remains an important aspect of patient management in visceral leishmaniasis (VL). However, transfusion triggers considered are poorly understood. This review summarises the transfusion practices adopted in VL efficacy studies using the Infectious Diseases Data Observatory VL clinical trials library. Of the 160 studies (1980-2021) indexed in the IDDO VL library, description of blood transfusion was presented in 16 (10.0%) (n=3459 patients) studies. Transfusion was initiated solely based on haemoglobin (Hb) measurement in nine studies, combining Hb measurement with an additional condition (epistaxis/poor health/clinical instability) in three studies and the criteria was not mentioned in four studies. The Hb threshold range for triggering transfusion was 3-8 g/dL. The number of patients receiving transfusion was explicitly reported in 10 studies (2421 patients enrolled, 217 underwent transfusion). The median proportion of patients who received transfusion in a study was 8.0% (Interquartile range: 4.7% to 47.2%; range: 0-100%; n=10 studies). Of the 217 patients requiring transfusion, 58 occurred before VL treatment initiation, 46 during the treatment/follow-up phase and the time was not mentioned in 113. This review describes the variation in clinical practice and is an important initial step in policy/guideline development, where both the patient's Hb concentration and clinical status must be considered.
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