Infection Rates in Autologous Hsct with Prbc Transfusion

Introduction: Infection remains a dominant source of morbidity/mortality for patients undergoing myeloablative chemotherapy and autologous stem cell transplant (ASCT). We sought to determine the relative risk of infection with the use of packed red blood cell (pRBC) transfusion to treat chemotherapy associated anemia.

Methods: Patients who underwent ASCT at Pennsylvania Hospital between 1995 and 2019 were identified. Data on transfusion status and infection were obtained from patient discharge and transplant summary forms including: Participation in bloodless medicine program, number of units of pRBCs transfused, and documented post-transplant infection. Standard 2 variable relative risk analysis and odds ratio were calculated to assess association between transfusion use and post-transplant infection rate.

Results: 306 patients were identified to have undergone ASCT with 176 (57.7%) participating in the bloodless medicine program, 46 (15.1%) having no need of pRBC, and 83 (27.1%) receiving at least 1 unit of pRBC. Median number of pRBC in transfused patients was 2 units. Rate of infection among those who did not receive pRBC was 33.3% while it was significantly higher in those who did at 49.4%. Patients who received pRBC were at higher risk of developing infection (Relative risk (RR) 1.48, odds ratio (OR) 1.95, 95% confidence interval (CI) 1.17-3.26, p=0.01) than those who did not. Further analysis showed that higher quantity of pRBC units further increased infection risk in patients who got 4 or more units of pRBC (RR=1.97, OR=4.14, CI=1.814-9.450, P=.0007).

Conclusion: Infection after ASCT was more common with the use of pRBC transfusion to treat anemia while number of pRBC units was positively correlated with rates of infection. This area needs further study to better plot timelines of events as well multiple regression analysis to control for confounding variables such as relative levels of neutropenia before onset of infection.