Reducing blood transfusion in dialysis unit

Abstract

REDUCING BLOOD TRANSFUSION IN DIALYSIS UNIT Ruth Yang, John Cunningham, John Connolly & Colley Crawford London UK Blood transfusions are generally detrimental to dialysis patients and should be avoided when possible (Daugirdas J 1994). The risks for patients, including: ABO incompatibility; anaphylactic reaction; transmission of virus infection such as hepatitis B,C or HIV; jeopardy of a prospect for renal transplantation. The dialysis unit has 110 patients. In 2002, 386 blood transfusion units were used. In 2003,we introduced a blood transfusion recording system aiming to monitor and reduce blood transfusion for the dialysis patients. It includes: 1) Introduction of Blood Transfusion Request form filled by doctors. It indicates the reason to prescribe. 2) Introduction of Blood Transfusion Record form filled by nurse for each transfusion. It includes date, patients name, HB, blood units and name of the doctor who prescribes. 3) Introduction of Blood Transfusion Folder. Both forms above are kept in it. The Anaemia co-ordinator produces an on going monthly audit of blood transfusion according to the data. A monthly anaemia review meeting is held between the nephrologists consultants, dialysis unit registrar and anaemia coordinator by using 1) a chart of all dialysis patients’ current Epo dose, monthly HB, MCV, HCT, reticulocyte count, fe, IBS, ferritin and CRP; 2) a trend record of HB and Epo dose for every patient on a monthly basis; 3) a chart with a graph indicating continuing Hb results according to the UK Renal Association, European Best Practice Guide and K/DOQI standards; 4) a chart with a graph indicating a correlation between average HB, average Epo dosage and blood transfusion each month. The result appeared encouraging. Blood transfusion has reduced by 62% in two yeas. Time Blood Transfusion units % 0 0 1 4 8 3 2 0 0 2 % 8 5 5 2 2 3 0 0 2 % 8 3 6 4 1 4 0 0 2 2005 140 36%