Less is not always best: review of restrictive transfusion strategies
Guidelines that promote the use of restrictive transfusion strategies in the name of patient blood management (PBM) are not supported by evidence for all patients populations, according to a new review by Australian and international haematologists.
While there is evidence supporting the overall safety of a restrictive transfusion strategy in many clinical settings, there are problems with transfusion trials relating to subgroups and the lack of patient centred outcomes, according to a review led by Dr Alison Mo of the Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Melbourne.
The lack of evidence for restrictive transfusion practices relates to groups such as patients with haematological malignancies and bone marrow failure syndromes, despite the high volume of blood use in these areas, they write.
“Ultimately, true PBM is not simply about numbers of units of blood used, but must also focus directly on the patient, and includes patient [Quality of Life] and function, and patient preferences, to optimise their transfusion management and allow best use of this precious community resource,” they conclude in the journal Transfusion.
New thrombosis advice for AZ vaccine
New UK advice on contraindications to vaccination with the AZ vaccine says there is no evidence that people with a prior history of thrombosis or known risk factors for thrombosis, including antiphospholipid syndrome are more at risk of developing this immune-mediated condition of thrombosis in combination with thrombocytopaenia after the AZ vaccine.
The advice from Public Health England, based on 24.3 million first doses and 13.4 million second doses of AZ vaccine given in the UK is that the overall incidence of thromboembolic events accompanied by thrombocytopenia
following the AZ vaccine is around 13.6 per million first or unknown doses and 1.3 per million second doses administered.
“There continue to be no safety concerns for this extremely rare adverse event following receipt of a second dose of the AZ vaccine. All those who have received a first dose of the AZ vaccine should continue to be offered a second dose of the AZ vaccine, irrespective of age,” the agency recommends.
Shingrix now available for immunocompromised patients
A non-live recombinant herpes zoster vaccine, Shingrix, is now available in on the private market in Australia, according to manufacturer GSK.
Shingrix is registered for Australian adults aged 50 years and over for the prevention of shingles and prevention of postherpetic neuralgia.
The new vaccine offers an alternative option to Zostavax for patients who are immunosuppressed because they are receiving chemotherapy or radiation therapy, and in whom live vaccine is contraindicated because of the risk of developing disseminated varicella-zoster virus (Oka vaccine strain) infection following administration of Zostavax vaccine. The two dose course intramuscular injections is reported to cost around $400-$500 on private prescription.