Abstract
Abstract Aim Correct prescription of red blood cells (RBCs) is essential for treatment of peri-operative anaemia and preventing complications to post-operative recovery. However, over prescription is costly, inefficient, and not free of complication. We compared the threshold and targets for the prescription of RBCs in a secondary care orthopaedic department to the NICE Blood Transfusion Guidance (2015) and whether altered thresholds were used or if iron was prescribed. Method Retrospective analysis of all surgically managed orthopaedic patients over a 3-month period receiving peri-operative RBCs in 2020. Pre and post transfusion haemoglobin (Hb) levels, concurrent prescription of iron and documented reasons for altered transfusion thresholds were collected. Exclusions included major trauma, major haemorrhage, or intra-operative transfusion. Results 62 patients were transfused on average 1.5 units post-operatively. 21.4% were transfused in line with the NICE threshold (Hb<70g/dL) and targets (Hb70–90g/dL.) Average Hb threshold was 75.5g/dL (range 60–110). 0% had an ACS on the day of RBC transfusion. In 54.2% 1 unit was prescribed at a time. Iron deficiency anaemia was identified in 11.4% and treated in 7% pre-operatively. Conclusions RBCs are being prescribed out of line with NICE guidance with a 21.4% compliance to the standard. The most common reason was a ‘coronary history’ which was inconsistently defined with no patients having an acute coronary syndrome - the only reason given by NICE for changing this threshold. Departmental education, identification of pre-operative anaemia and a protocol explaining the use of oral and intravenous iron peri-operatively may reduce the amount of erroneous blood transfusion prescribing in this cohort.
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