Transfusion thresholds in apheresis: Results from a survey and focus group discussion

BACKGROUND: Clinical practice guidelines for red blood cell (RBC) or platelet transfusion are not tailored specifically for therapeutic apheresis patients. It is unclear how provider transfusion thresholds in the peri-therapeutic apheresis period correlate with guidelines. We hypothesized that individual apheresis clinician practice would not wholly adhere to transfusion guidelines. STUDY DESIGN AND METHODS: A large, international survey was designed, beta tested, piloted and sent to all members of the Association for the Advancement of Blood & Biotherapies (AABB) Therapeutic Apheresis Subsection (n = 459). Responses of interest were used to generate discussion points for an open, expert-moderated focus group discussion at the 2024 AABB Annual Meeting. RESULTS: Total survey response rate was 10%, n = 47. Calculated sample size (survey responses) for 95% confidence level with a 10% margin of error was n = 80. Nonetheless, responses of interest were generated, including some responses deemed discordant with international guidelines. Five topics were discussed by the focus groups: (1) platelet transfusion thresholds, (2) transfusion methods prior to central venous catheter placement, (3) therapeutic plasma exchange platelet repletion, (4) hemoglobin transfusion threshold prior to RBC exchange, and (5) platelet transfusion threshold for initiating therapeutic plateletpheresis. CONCLUSION: The survey results and focus group discussion, framed within current international guidelines and the literature, highlighted the need for enhancing the value of apheresis providers' clinical judgment and ability to impact institutional policies.