A retrospective study on the use of blood products in the emergency department

Abstract

Background: Blood product transfusion occurs in a significant percentage of patients admitted in the emergency department. Adverse reactions occurring in the setting of transfusion are associated with increased morbidity and mortality and inadvertent use of blood can do more harm to the patient than good. Analyzing blood transfusion data will help in formulating policies for transfusion in the emergency medicine department (ED). Aim: To characterize transfusion requirements in the ED. Materials and Methods: This was a retrospective cohort study analyzing patients who required blood or blood product transfusion in the ED in January 2017. Results: The total number of patients requiring blood transfusions in January 2017 in the ED was 214, of which 56% were men with an average age of 44 years. The overall total number of blood products requested was 272, among them 78.7% of the blood products were ultimately transfused. Hematological diseases (30.4%) were the most common indication for blood product transfusion, followed by trauma (20.1%) and upper gastrointestinal bleed (18.7%). Among the blood products requested, 52.2% were packed red cells, 34.5% were platelet-rich concentrate, 8.1% were fresh frozen plasma, 3.7% were cryoprecipitate, and 1.5% were whole blood. The mean hemoglobin level for transfusion was 6.7 g/dL. Only 1.4% of patients developed adverse reaction during transfusion. Among the total study population, 58.4% of the patients were admitted, 34% of the patients were discharged stable, 6.5% of the patients took discharge against medical advice, and 1.1% of them died in the ED. Conclusion: There is large quantity of blood being transfused in the emergency department, for various indications. There is a discrepancy between the quantity cross-matched and that which is transfused. As we have characterized the same, we can further look at the policy-making for blood transfusions in the ED.