Evaluation of safety, efficacy, and guideline compliance in home‐based red blood cell transfusions: An 8.5‐year retrospective study in suburban Tokyo

OBJECTIVES: This study evaluated the safety, efficacy, and guideline adherence of home transfusions at a single institution over nearly a decade. BACKGROUND: In Japan, demand for home-based red blood cell (RBC) transfusions is increasing due to population aging and promotion of community-based care. Although national guidelines were issued by the Japanese Society of Transfusion Medicine and Cell Therapy (JSTMCT) in 2017, evidence regarding their real-world application and safety remains limited. METHODS/MATERIALS: We retrospectively reviewed 1007 planned RBC transfusion procedures in 181 patients (median age 81 years, range 37-97) between March 2016 and September 2024 in suburban Tokyo. Data included patient characteristics, transfusion details, haemoglobin (Hb) levels, adverse events, and JSTMCT guideline compliance. Paired Hb values were analysed using the Wilcoxon signed-rank test. RESULTS: Malignancy was the most common underlying condition (173/181 patients, 95.6%), with haematological disorders predominant (102/181, 56.4%). Of 1007 planned procedures, 48 (4.8%) were cancelled. The median number of procedures per patient was 7 (range 1-232). Among 410 procedures with paired Hb values within 15 days, Hb increased significantly (median 6.8 g/dL pre- vs. 7.4 g/dL post-transfusion, p < 0.05). Mild adverse reactions occurred in 0.31% (3/959), lower than the JSTMCT-reported hospital rate of 0.64%. Compliance with JSTMCT guidelines was highest for caregiver presence (100%) but lowest for initial hospital-based transfusion (74.6%). CONCLUSION: Home-based RBC transfusions demonstrated excellent safety and efficacy profiles with lower adverse reaction rates than hospital-based transfusions. This study suggests that the JSTMCT guideline revisions should consider real-world practices, particularly initial transfusion requirements and hospital-clinic collaboration.