P19 Appropriateness of Red Cell Transfusion in Medical patients

Abstract

There is now increasing attention focused on promoting appropriate use of blood transfusion on the background of significant concerns regarding safety. Wide variations have been described in surgical usage of blood but there is relatively little data available on red cell transfusion in medical patients with anemia.Methods We retrospectively audited transfusion practice in general medical patients over a 1 month period. Appropriateness of transfusion was assessed against national guidance (British Journal of Haematology 2001; 113, 24). Documentation of transfusion episodes was measured against the criteria given in Better Blood Transfusion (HSC 2002/009). Over‐transfusion was classified as a post transfusion haemoglobin (Hb) increment of >2 g dL−1 above transfusion threshold.Results Out of 72 consecutive cases audited, 18 were excluded (three patients transferred to surgical care, five on long term transfusion regimes, 10 case notes unavailable). Data was available on 54 patients (31F;23M) aged 23 to 91 years (mean 67 years) with a wide variety of medical diagnoses. 66 cross‐matches were undertaken resulting in 56 transfusions. 201 units of red cells were cross‐matched with 15 units transfused giving a transfusion ratio of 1.3 and a transfusion index of 2.8. 55 cross‐matches (83.5%) were assessed as appropriate and of these four were not transfused. The indication for transfusion was not recorded in 21% (n = 14) of cases and the outcome was not recorded in 20% (n = 11) of cases. Pre‐transfusion Hb levels ranged between 5.4 g dL−1 and 12.7 g dL−1 (mean 8.2 g dL−1). Post transfusion Hbs ranged between 7.0 g dL−1 and 15.2 g dL−1 (mean 10.7 g dL−1); there were no post transfusion Hb samples taken in five cases (7.6%). The post transfusion increment was found to be >2 g dL−1 in 51.5% (n = 34) of transfusions.Conclusions The documentation of transfusions remains poor with indications and outcome not being recorded in a significant proportion of medical cases audited. Over 15% of cross‐matches were found to be inappropriate against objective audit criteria and there was evidence of overtransfusion. Transfusion practice for medical indications warrants further scrutiny with a view to promoting appropriate use of red cells and better documentation to improve safety.