P123: Retrospective review of transfusions for anemia ordered in the emergency department and concordance with guidelines

Abstract

Introduction: Iron Deficiency Anemia (IDA) is a common presentation to the emergency department (ED) and is often treated with red blood cell transfusions. Choosing Wisely and the American Association of Blood Banks released guidelines in 2016 outlining under what circumstances transfusions should be given for patients with IDA. Few well-powered studies have looked at the impact of these guidelines on transfusions in EDs. The goal of this study was to examine the number of RBC transfusions that were given in EDs in Calgary, Alberta from 2014-2018 and what proportion of these were potentially avoidable (PA). Methods: We analyzed 8651 IDA patient encounters from 2014–2018 at four centers in the Calgary Zone. A transfusion was considered PA if the patient's hemoglobin (hgb) was ≥70 g/L AND if the patient was hemodynamically stable. We performed descriptive statistics to assess the number of transfusions and the number of avoidable transfusions. We used chi-squared tests to determine if there were significant differences between site, time-period, hemoglobin level. Results: In total, 990 (11.4%) of the encounters received transfusions; 711 (71.8%) were indicated while 279 (28.1%) were PA. Out of the transfusions that were indicated, 230 (32.3%) were given to patients with a hgb <70 g/L and 481 (67.7%) were given to patients with a hgb >70 g/L but who were hemodynamically unstable. Out of the transfusions that were PA, the highest number were given to those in the 71-80 g/L hgb group (142) and the lowest number were given to those in the 110-130 g/L hgb group (9), a difference that was statistically significant (p < 0.001). The PA transfusion rates from 2014 to 2018 were 30.8%, 25.6%, 34.5%, 23.6%, 20.7% respectively, which was a statistically significant difference (p = 0.004). Conclusion: Our data suggest that the number of PA transfusions at the hospitals in the Calgary zone is comparable to the rates reported in the existing literature. In addition, the rate of PA transfusions has decreased since the release of the guidelines. A limitation of the present study was that it did not look at the number of units of red blood cells transfused and since many patients receive more than one unit, it is possible that the number of PA transfusions was underestimated. Nevertheless, we intend to use our results to create a safer and more cost-effective approach to managing IDA.