Seeking Strategies to Optimize Blood Utilization: The Preliminary Experience with Implementing a Patient Blood Management Program in a Greek Tertiary Hospital.

Aimilia Tsante,Serena Valsami,Elias Kyriakou,Anastasia Papandreadi,Daniele Piovani,Andreas G Tsantes,Panagiota Douramani,Athina Kypraiou,Petros Kopterides,Argirios E Tsantes,Electra Loukopoulou,Styliani I Kokoris,Aristarchos Poulis,Stefanos Bonovas,Argyri Gialeraki

doi:10.3390/jcm10102141

Abstract

Objectives: Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. Methods: An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. Results: Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. Conclusion: A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.

Highlights

Red blood cell (RBC) transfusion is the mainstay to correct anemia, but it is considered a frequently abused procedure since the indication for RBC transfusion remains uncertain
The initial analysis examined the total number of RBC units transfused, the mean number of units transfused per patient, and the mean number of units transfused per hospitalized patient for a one-year period before and after implementing an electronic
To monitor transfusion practice in medical patients during the one-year prospective audit implementation period, additional analyses included estimation of the Hb thresholds used for RBC transfusions in clinical practice, proportion of inappropriate transfusions based on pre-specified audit criteria, and the mean number of RBC units transfused per transfusion episode or clinical specialty

Summary

Introduction

Red blood cell (RBC) transfusion is the mainstay to correct anemia, but it is considered a frequently abused procedure since the indication for RBC transfusion remains uncertain. An increased emphasis has been given on optimizing blood utilization through a variety of modalities, including appropriate blood use through the successful implementation of evidence-based transfusion guidelines and highlighting the need to decrease unnecessary transfusions while ensuring that those who need blood get what they need. Patient blood management (PBM) has been defined as “the appropriate use of blood and blood components, with a goal of minimizing their use” [3] and refers to “the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin (Hb) concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome” [4]. Audits combined with transfusion guidelines in association with real-time clinical decision support systems are considered critical [5]

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Conclusion