Abstract
BACKGROUND AND AIMS: Home blood transfusion is thought to be a promising solution for reducing the burden of hospital visits for elderly patients with hematologic diseases such as myelodysplastic syndrome and leukemia. However, safety concerns and reliance on nonprofessional attendants currently limit its widespread adoption in Japan. We evaluated feasibility (completion of scheduled measurement points per transfusion day) and operational safety (frequency of alerts and proportion leading to clinical actions) of intermittent vital sign monitoring with real-time remote alerts during home blood transfusions in Japan. METHODS: Five patients receiving home transfusions via Akasaka Clinic between December 2022 and February 2023 participated in the study. A digital tablet-based system was preconfigured to connect with Bluetooth-enabled vital sign devices (blood pressure monitor, thermometer, and pulse oximeter). Before transfusion, baseline vital signs were measured by the visiting physician; attendants then measured vitals at 15 and 60 min and at the end of transfusion. Data were automatically transmitted to physicians via the Heartline™ system. If preset thresholds were exceeded, alerts were triggered, which prompted professional medical intervention. RESULTS: During the 30-day trial period, red blood cell transfusions were performed 27 times (each consisting of 2 units), and platelet concentrate transfusions were performed 15 times (each consisting of 10 units). Measurement completion rates ranged from 38% to 94% (median 70% [IQR 53-88]). Alerts occurred on 12/30 days and totaled 12 alert events, corresponding to 28.6 alerts per 100 transfusions. Four of 12 alert events (33.3%) led to clinical actions (medication administration or initiation of home oxygen). Notably, intermittent measurement effectively identified clinically significant changes. Attendants, including elderly cohabitants, were able to operate the system with minimal burden. CONCLUSION: Intermittent, attendant-performed vital sign monitoring with real-time alerts enabled timely clinical responses and was feasible, even among elderly caregivers.