Variations in blood transfusion practices among South African haematology providers: A survey of haemato-oncology and haematopoietic stem cell transplant prescribers

Abstract

BACKGROUND: Patients with haematological malignancies and haematopoietic stem cell transplant recipients are major consumers of blood products. In South Africa (SA), both medical oncologists and clinical haematologists (haematology providers) manage these patients. We hypothesised that there may be varied blood transfusion practices between these two specialty groups. OBJECTIVES: To compare red blood cell (RBC) and platelet transfusion practices among haematology providers in SA, focusing on transfusion thresholds, blood product modifications and differences between clinical haematologists and medical oncologists. METHODS: We conducted an online REDCap survey among SA haematology providers, including clinical haematologists (and trainees), medical oncologists (and trainees), paediatric oncologists/haematologists (and trainees) and medical officers managing haemato-oncology patients. RESULTS: The survey response rate was 51% (79/155), of which 58 (73%) responses were complete and eligible for analysis. RBC and prophylactic platelet transfusion thresholds were generally similar across haematology providers. However, significant variation was observed in platelet thresholds for central venous catheter insertion, lumbar puncture and major surgery. Marked inconsistency was also noted in clinicians' understanding of when blood product irradiation is indicated. CONCLUSION: This study confirms a variation in blood transfusion practices and blood product modification requests between haematology providers. This emphasises the need for targeted education and national standardisation efforts to optimise transfusion practice and ensure patient safety.