Appropriateness Of Transfusion Research Articles

Evaluation of the Appropriateness of Platelet Transfusions at Two Tertiary Hospitals

Evaluation of the Appropriateness of Platelet Transfusions at Two Tertiary Hospitals

Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program.

In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.

A simple program to improve the appropriateness of red blood cell transfusions in non-bleeding hospital patients: a before-and-after study.

Transfusion of red blood cells (RBCs) is not devoid of risks; nor is anemia. The aim of the study was to assess the usefulness of a program designed to improve the appropriateness of RBC transfusions in hospital patients.Methods: We retrospectively analyzed time periods before and after program implementation. Before program implementation 415 out of 23492 (1.8%) patients received at least 1 RBC, whereas after implementation 162 out of 25062 (0.6%) did so. The percentage of appropriate RBC transfusions increased from 23.6 to 37.1%. A simple program may lead to a 3-fold decrease in transfusion rate and a significant increase in the percentage of appropriate RBC transfusions.

Evaluation of Appropriateness of Platelet transfusions in a Tertiary Care Centre

Evaluation of Appropriateness of Platelet transfusions in a Tertiary Care Centre

A-175 Objective Indexes for Comparing Platelet Usage Among Peer Hospitals During the COVID-19 Pandemic

Abstract Background Besides hospital size, clinical diagnosis and severity of patients’ cases determine the total platelet transfusions of each hospital. Therefore, the appropriateness of platelet usage could not be simply compared with the total units of platelet usage among hospitals of different sizes. This study aimed to establish objective indexes that can appropriately reflect the differences in platelet usage in various hospitals. Methods We used three objective indexes X, Y, and Z to compare the appropriateness of platelet transfusions among different hospitals. Instead of considering various factors such as hospital size, patient population, and disease diagnosis individually, three indexes were generated by dividing the annual total units of platelet usage by total annual reimbursement, the total number of admissions, and the average total reimbursement per admission for each hospital, respectively. Results Total units of platelet usage were only directly related to the sizes of hospitals. New indexes X and Y alleviated the hospital size-dependent difference. Index Y was considered a better option than index X, as its value fluctuated less during the COVID-19 pandemic. Index Z was adjusted with the average total reimbursement per admission, and its results showed that more patients of higher disease complexity did not result in more platelet usage during the COVID-19 pandemic. Conclusion These three objective indexes are suitable for peer comparison and monitoring the platelet usage of hospitals irrespective of their size.

Let Us Know Transfusion Triggers for Prophylactic Use of Platelet Concentrate-Analysis of Compliance with Recent Transfusion Guidelines in a Large Academic Medical Center.

Platelet concentrate (PC) is a blood component that is used to prevent or manage bleeding associated with thrombocytopenia or impaired platelet function. The aim of our study was to assess the compliance of ordering physicians with the most recent PC transfusion guidelines in our academic medical center. All PC transfusions performed between January 2019 and December 2022 were analyzed. The appropriateness of PC transfusions was assessed based on the most recent PC transfusion guidelines. During 2019-2022, there were 362 (0.2%) PC recipients out of 161,762 hospitalized patients. There were 971 PCs transfused during the analyzed period. Inappropriate transfusions accounted for 53.3% of cases, and most of them were given prophylactically (80.2%). Compliance with platelet transfusion guidelines varied among departments. The overall percentage of inappropriately transfused PC ranged from 50.7% to 60.8% in successive years. Educational activities should target clinicians performing procedures associated with high rates of inappropriate PC transfusions. Implementing clinical decision support systems can help reduce unnecessary PC transfusions and associated costs. The majority of inappropriate PC transfusions in our medical center were given as prophylaxis against bleeding. Prescribers should be educated about evidence-based transfusion triggers for the prophylactic use of PC in various clinical scenarios.

Paediatric clinical decision support: Evaluation of a best practice alert for red blood cell transfusion.

Providing red blood cell (RBC) transfusion to paediatric patients with a haemoglobin (Hb) level of <7 g/dL is the current best practice, but it is often difficult to ensure appropriateness of RBC transfusion on a health system level. Electronic health record (EHR) clinical decision support systems have been shown to be effective in encouraging providers to transfuse at appropriate Hb thresholds. We present our experience with an interruptive best practice alert (BPA) at a paediatric healthcare system. An interruptive BPA requiring physician response was implemented in our EHR (Epic Systems Corp., Verona, WI, USA) in 2018 based on Hb thresholds for inpatients. The threshold was initially <8 g/dL and later changed to <7 g/dL in 2019. We assessed total activations, number of RBC transfusions and hospital metrics through 2022 compared to the 2 years prior to implementation. The BPA activated 6956 times over 4 years, slightly less than 5/day, and the success rate, with no RBC transfusions within 24 h of order attempt, was 14.5% (1012/6956). There was a downward trend in the number of total RBC transfusions and RBC transfusions per admission after implementation, non-significant (p = 0.41 and p = >0.99). The annual case mix index was similar over the years evaluated. The estimated cost savings based on acquisition costs for RBC units were 213,822 USD or about $51,891 per year. BPA implementation led to sustained change in RBC transfusion towards best practice, and there were long-term savings in RBC expenditure.

An Evaluation of the Appropriateness of Platelet Transfusion and Transfusion Effects of Platelet Products

An Evaluation of the Appropriateness of Platelet Transfusion and Transfusion Effects of Platelet Products

The appropriateness of platelet transfusions in hematological patients and the potential for improvement.

Hematology patients are intensive platelet users. In clinical practice, a substantial proportion of platelet (PLT) transfusions are routinely administered outside the guidelines despite compelling evidence for recommendations. Those unnecessary PLT transfusions are an unjustified extra burden on a scarce healthcare resource and may also be detrimental to the patients. This study aims to evaluate indications and assess the appropriateness of PLT transfusion, as well as to identify common discrepancies and propose modalities for better compliance with guidelines. The audit of all PLT orders for adult hematological inpatients was conducted over 2months. The assessment was performed using guidelines for PLT transfusion. Patient demographic, clinical, and transfusion data were collected from hospital electronic medical records. Based on 286 PLT orders, 344 PCs were transfused to 67 patients: 235 (82.2%) prophylactical due to low PLT count, 34 (11.9%) preprocedural and 17 (5.9%) therapeutic. Overall, 105 (36.77%) PLT transfusions were inappropriate: 78 (33.2%) of all prophylactic PLT transfusions due to low PLT count, 17 (50%) off all preprocedural and 10 (58.8%) of all therapeutical transfusion. The major reason for PLT transfusion inappropriateness was transfusion above the recommended threshold. Double units of PCs were transfused in 36.7% of all PLT transfusions and 32.4% of them were considered inappropriate. Our audit of PLT transfusion practice found a large proportion of inappropriate PLT transfusions. Based on the most common deviations from the guidelines a variety of targeted measures for improvement are proposed.

Predictive indicators for determining red blood cell transfusion strategies in the emergency department.

Appropriate decision-making is critical for transfusions to prevent unnecessary adverse outcomes; however, transfusion in the emergency department (ED) can only be decided based on sparse evidence in a limited time window. This study aimed to identify factors associated with appropriate red blood cell (RBC) transfusion in the ED by analyzing retrospective data of patients who received transfusions at a single center. This study analyzed associations between transfusion appropriateness and sex, age, initial vital signs, an ED triage score [the Korean Triage and Acuity Scale (KTAS)], the length of stay, and the hemoglobin (Hb) concentration. Of 10 490 transfusions, 10 109 were deemed appropriate, and 381 were considered inappropriate. A younger age ( P < 0.001) and a KTAS level of 3-5 ( P = 0.028) were associated with inappropriate transfusions, after adjusting for O 2 saturation and the Hb level. In this single-center retrospective study, younger age and higher ED triage scores were associated with the appropriateness of RBC transfusions.

Appropriateness of packed red blood cells transfusions in chronic anemic patients in the emergency department: the TRANSFUS-ED retrospective analysis

Patients suffering from chronic anemia can benefit from scheduled transfusions of packed red blood cells (PRBCs), while urgent transfusions have specific indications. These patients frequently seek medical attention in the emergency department (ED), where they can be inappropriately transfused, but research in this field is limited. This study aimed to assess the appropriateness of PRBCs transfusions in chronic anemic patients in the ED. A retrospective analysis was performed on patients who accessed the ED of the Azienda Ospedaliera di Padova (Padova, Italy) between 2016 and 2019 and received PRBCs transfusions. Patients aged ≥ 18 years old and with chronic anemia were included, while those with acute anemia or admitted to the hospital after the transfusion were excluded. Chronic anemia was defined as satisfying one of the following in the past medical history: diagnosis of chronic anemia; two or more previous blood samplings demonstrating anemia; periodic transfusions. As primary outcome, the appropriateness of transfusions was assessed according to the American Association of Blood Banks (AABB) 2016 criteria, using the recommended threshold of 7 g/dL for hemodynamically stable adults and 8 g/dL for patients with pre-existing cardiovascular disease. Out of 1153 transfusions, 344 transfusions were included in the study. According to our criteria, 139 (40.4%) patients were inappropriately transfused, resulting in a total estimated cost of 54,528.71 € in the study period. This study showed that transfusions in chronic anemic patients are recurrent events in the ED and are frequently inappropriate. A possible explanation could be the lack of a well-structured primary care network granting periodic transfusions in ambulatory centers. In the future, implementing and improving chronic anemic patients’ access to transfusion services through dedicated pathways could reduce the burden on the ED and also decrease costs.

Community-Based Hospitals Benefit From Restrictive Transfusion Practices.

Blood availability was uncertain during the COVID-19 pandemic, yet transfusion remained a common and sometimes necessary procedure. Substantial work on optimizing transfusion practices is centered in tertiary hospitals as high utilizers of blood while the care delivered in smaller community hospitals comprises more than half the nation's transfusions. Improving transfusion practices in community hospitals represents a substantial opportunity to enhance patient safety and the availability of blood resources. Clinical specialists developed a dashboard to retrospectively examine transfusion events including an evidence-based analysis of the patient's clinical situation at the time of transfusion to more accurately identify how appropriately blood was used. The compiled data were discussed and shared with transfusing providers. It was hypothesized that the data provided and communication strategies used would educate providers to current evidence-based practice, leading to more appropriate transfusion with an overall reduction in packed red blood cell utilization. There was an 11% increase in transfusion appropriateness (p = <.001) and a 14% decrease in the units transfused (p = .004). Improvement in transfusion practices demonstrates a significant impact on patient safety and the availability of blood resources. Although absolute opportunity may be less in a community hospital, fewer resources are needed to achieve meaningful change.

Appropriateness of Allogeneic Red Blood Cell Transfusions in Non-Bleeding Patients in a Large Teaching Hospital: A Retrospective Study.

In hemodynamically stable patients, both anemia and red blood cell (RBC) transfusion may be detrimental to patients; hence, a decision regarding RBC transfusion should be based on thorough risk-benefit assessment. According to hematology and transfusion medicine organizations, RBC transfusion is indicated when recommended hemoglobin (Hb) triggers are met, and symptoms of anemia are present. The aim of our study was to examine the appropriateness of RBC transfusions in non-bleeding patients at our institution. We performed a retrospective analysis of all RBC transfusions performed between January 2022 and July 2022. The appropriateness of RBC transfusion was based on the most recent Association for the Advancement of Blood and Biotherapies (AABB) guidelines and some additional criteria. The overall incidence of RBC transfusions at our institution was 10.2 per 1000 patient-days. There were 216 (26.1%) RBC units appropriately transfused and 612 (73.9%) RBC units that were transfused with no clear indications. The incidence of appropriate and inappropriate RBC transfusions were 2.6 and 7.5 per 1000 patient-days, respectively. The most frequent clinical situations when RBC transfusion was classified as appropriate were: Hb < 70 g/L plus cognitive problems/headache/dizziness (10.1%), Hb < 60 g/L (5.4%), and Hb < 70 g/L plus dyspnea despite oxygen therapy (4.3%). The most frequent causes of inappropriate RBC transfusions were: no Hb determination pre-RBC transfusion (n = 317) and, among these, RBC transfused as a second unit in a single-transfusion episode (n = 260); absence of anemia sings/symptoms pre-transfusion (n = 179); and Hb concentration ≥80 g/L (n = 80). Although the incidence of RBC transfusions in non-bleeding inpatients in our study was generally low, the majority of RBC transfusions were performed outside recommended indications. Red blood cell transfusions were evaluated as inappropriate mainly due to multiple-unit transfusion episodes, absence of anemia signs and/or symptoms pre- transfusion, and liberal transfusion triggers. There is still the need to educate physicians on appropriate indications for RBC transfusion in non-bleeding patients.

Evaluation of Six Years of Appropriateness Level of Blood Transfusion in a Pediatric Ward.

Blood transfusion can be considered as a life-saving treatment and is a primary health management topic. This study aims to assess the appropriateness of blood transfusion performed in a large tertiary hospital in Italy. a multispecialist team composed oof hematologists, public health experts and pediatricians analyzed blood transfusions performed between 2018 and 2022 in the pediatric wards comparing the appropriateness with the available NHS guidelines available. Patients' characteristics, clinical features and blood component's data were collected and analyzed. considering 147 blood transfusions performed in 2018-2022, only eight (5.4%) were performed according to guidelines, while 98 (66.7%) were driven by clinicians' expertise, especially for anemia in genetic syndromes (30) (20.5%) and autoimmune diseases (20) (13.6%). Thirty-nine (26.5%) transfusions could be considered as inappropriate, while two (1.4%) blood packs were never been transfused after being requested. This analysis is one of the first performed to assess the appropriateness of blood component transfusions comparing their compliance to NHS guidelines. The importance of this analysis can be explained first by the clinical point of view and second by the economic one.

Effect of a Patient Blood Management Program on the Appropriateness of Red Blood Cell Transfusion and Clinical Outcomes in Elderly Patients Undergoing Hip Fracture Surgery.

Elderly patients with hip fractures frequently receive perioperative transfusions, which are associated with increased morbidity and mortality. This study aimed to evaluate the impact of a patient blood management (PBM) program on the appropriateness of red blood cell (RBC) transfusion and clinical outcomes in geriatric patients undergoing hip fracture surgery. In 2018, the revised PBM program was implemented at the Korea University Anam Hospital, Seoul, Republic of Korea. Elderly patients aged ≥ 65 years who underwent hip fracture surgery from 2017 to 2020 were evaluated. Clinical characteristics and outcomes were analyzed according to the timing of PBM implementation (pre-PBM, early-PBM, and late-PBM). Multiveriate regression analysis was used to evaluate the risk factors of the adverse outcomes, such as in-hospital mortality or 30-day readmission. A total of 884 elderly patients were included in this study. The proportion of patients who received perioperative RBC transfusions decreased significantly (43.5%, 40.1%, and 33.2% for pre-PBM, early-PBM, and late-PBM, respectively; P = 0.013). However, the appropriateness of RBC transfusion significantly increased (54.0%, 60.1%, and 94.7%, respectively; P < 0.001). The duration of in-hospital stay and 30-day readmission rates significantly decreased. Multivariable regression analysis revealed that RBC transfusion (odds ratio, 1.815; 95% confidence interval, 1.137-2.899; P = 0.013) was significantly associated with adverse outcomes. Implementing the PBM program increased the appropriateness of RBC transfusion without compromising transfusion quality and clinical outcomes. Therefore, adopting the PBM program may improve the clinical management of elderly patients following hip fracture surgery.

Utilisation of Different Blood Components in Paediatric Patients: A Cross-sectional Study

Introduction: The term “blood component” refers to the separation of Whole Blood (WB) into packed red cells, platelet- rich plasma, Fresh Frozen Plasma (FFP), cryoprecipitate, and leukocytes. The practice of separating donated WB units into different blood components and supplying only those components to patients is now considered a standard practice in all blood banks. Therefore, regular auditing of blood usage and its components is essential to assess blood utilisation patterns. Aim: The aim of this study was to analyse the distribution and appropriateness of blood and blood product transfusions in children aged 1-18 years. Materials and Methods: A cross-sectional study was conducted over an 18-month period from December 1, 2014, to June 30, 2016, involving paediatric patients requiring blood and blood product transfusions, who presented to the Department of Paediatrics, Shri B.M. Patil Medical Hospital, Vijayapura, Karnataka, India. The study population consisted of children aged 1-18 years. Data from blood component requisition forms were collected, and reports of investigations such as pre-transfusion/ post-transfusion haematological parameters, coagulogram, and peripheral smear were recorded. Predetermined criteria were used to assess each transfusion episode. The results were then analysed, tabulated, and expressed as a percentage. The appropriateness of Packed Red Blood Cell (PRBC), platelet, and FFP transfusions was estimated using predetermined criteria. Data from blood component requisition forms were collected, coded, tabulated, analysed, and expressed as a percentage. Results: The study included 149 paediatric patients aged 1 to 18 years. Out of a total of 214 episodes of blood and blood component transfusions among the 149 patients, 102 episodes (47.7%) were WB transfusions, 67 episodes (31.3%) were packed red cell transfusions, 26 episodes (12.1%) were platelet transfusions, and 19 episodes (8.9%) were FFP transfusions. Out of the total 214 transfusion episodes, 126 (58.5%) were deemed appropriate, while 88 (41.5%) were deemed inappropriate. The most commonly inappropriately used component was WB, followed by platelets, FFP, and packed red cells. Inappropriateness of WB usage was primarily due to attempts to achieve haemostasis in bleeding patients, while sepsis was the most common indication for inappropriate platelet usage. Conclusion: This audit highlights significant variation in transfusion practice patterns among paediatricians. The most common indications for usage were found to be achieving haemostasis, threshold haemoglobin concentration, and sepsis in children.

Evaluation of appropriateness of red blood cell transfusions: A prospective audit at a tertiary care oncology centre

Evaluation of appropriateness of red blood cell transfusions: A prospective audit at a tertiary care oncology centre

Appropriateness of transfusions of red cells, platelets and fresh frozen plasma: An audit in referral hospitals in Tanzania

Background: The global scarcity of blood with imbalanced level of safety is not an exception in Tanzania. This necessitates rational use of blood components to optimise the usage of the available blood components to save lives while instituting safety measures to ensure that blood transfusion is safe. This audit aimed to determine current hospital practices about the appropriateness of transfusions of red cells, platelet and fresh-frozen plasma (FFP) in referral hospitals.Methods: This was a retrospective cross-sectional study involving secondary data of 1,150 index transfusions from twelve referral hospitals. Multistage cluster and random sampling procedures were used to obtain referral hospitals and index transfusions from blood bank registers respectively. Data were analysed using Stata version 14.1. The categorical variables were summarised into frequency and percentages, while continuous variables were summarised into median with their interquartile range.Results: In the present audit, 1 150 index blood transfusion episodes were recorded, with only (n=468; 40.7%) indicating the type of blood component in the request form. Among blood component indicated by type, 460 whole blood/red cells units were requested and transfused. Out of 460 blood units, less than one third (n=151; 32.8%) were appropriately transfused. The rest of the blood components FFP (n=3) and platelet concentrate (n=5) were inappropriately transfused.Conclusions: The study highlighted a low proportion of appropriate usage of blood and blood component. Educational efforts addressing appropriate use of blood component should be strengthened in transfusing hospitals with emphasis on proper documentation along with scale-up blood component production in the country.&#x0D; Contexte : La pénurie mondiale de sang avec un niveau de sécurité déséquilibré n'est pas une exception en Tanzanie. Cela nécessite une utilisation rationnelle des composants sanguins pour optimiser l'utilisation des composants sanguins disponibles pour sauver des vies tout en instituant des mesures de sécurité pour garantir la sécurité de la transfusion sanguine. Cet audit visait à déterminer les pratiques hospitalières actuelles quant à la pertinence des transfusions de globules rouges, de plaquettes et de plasma frais congelé (PFC) dans les hôpitaux de référence.Méthodes : Il s'agissait d'une étude transversale rétrospective impliquant des données secondaires de 1 150 transfusions index de douzehôpitaux de référence. Des procédures d'échantillonnage en grappes et aléatoires à plusieurs étapes ont été utilisées pour obtenir les hôpitaux de référence et les transfusions d'index à partir des registres des banques de sang, respectivement. Les données ont été analysées à l'aide de la version 14.1 de Stata. Les variables catégorielles ont été résumées en fréquence et en pourcentage, tandis que les variables continues ont été résumées en médiane avec leur intervalle interquartile.Résultats : Dans le cadre du présent audit, 1 150 épisodes de transfusion sanguine index ont été enregistrés, avec seulement (n=468 ; 40,7 %) indiquant le type de composant sanguin dans le formulaire de demande. Parmi les composants sanguins indiqués par type, 460 unités de sang total/globules rouges ont été demandées et transfusées. Sur 460 unités de sang, moins d'un tiers (n=151 ; 32,8 %) ont été correctement transfusés. Le reste des composants sanguins PFC (n = 3) et le concentré plaquettaire (n = 5) ont été transfusés de manière inappropriée.Conclusions : L'étude a mis en évidence une faible proportion d'utilisation appropriée du sang et des composants sanguins. Les efforts éducatifs portant sur l'utilisation appropriée des composants sanguins doivent être renforcés dans les hôpitaux de transfusion en mettant l'accent sur une documentation appropriée ainsi que sur l'intensification de la production de composants sanguins dans le pays.

Evaluation of blood component transfusion in sick neonates- a retrospective study in a rural tertiary new-born care unit of Eastern India

Background: In recent past, blood transfusion in neonates has developed a lot improving the outcome particularly in premature and low birth weight babies. However, there are no globally followed standardised guidelines for neonatal blood transfusion. The present study conducted with the objective to evaluate the frequency, indications, complications and appropriateness of various blood components transfusion in sick newborn care unit (SNCU) of a resource poor setting.Methods: This retrospective, hospital based, single centre observational study is done in a tertiary care SNCU of a teaching hospital of eastern India. All SNCU admitted neonates who received blood/ blood component transfusion from October 2018 to September 2019 were evaluated for blood component usage and their indications and followed up throughout hospital stay. The data were statistically analysed using Microsoft Excel™ software.Results: In this study 219 neonates received a total of 359 bags of blood component transfusion. Out of these packed red blood cell (PRBC), fresh frozen plasma (FFP), random donor platelet and whole blood were 233 (64.90%), 97 (27.01%), 10 (2.78%) and 19 (5.29%) respectively. The major indications for transfusion were anaemia of prematurity (35.37%), sepsis (26.18%) and bleeding disorder (16.71%). The common transfusion-related complications observed in our study were cardiac abnormality (22.35%), electrolyte disturbance (6.40%) and hypoglycaemia (19.17%).Conclusions: Anaemia of prematurity was the foremost indication of transfusion. Multiple transfusions were associated with prematurity and low birth weight.

A STUDY ON APPROPRIATENESS OF PACKED RED BLOOD CELLS TRANSFUSION IN A TERTIARY CARE HOSPITAL

Blood is scarce resource that can be used for saving lives. The goal is to provide this resource appropriately for the specific deficiencies. The main aim of the study was to assess the appropriateness of packed red blood cells in various departments of a tertiary care hospital.METHODS: A total of 1000 patients were included in the study. A structured excel sheet was made to analyze the various parameters that indicate the appropriateness of PRBC Transfusion. Statistical analysis was done using statistical software.RESULTS: The study showed that there was quite higher rate of appropriateness in the transfusion. Out of 1000 patients who had undergone transfusion of 1-unit PRBC,952 transfusions were appropriate in which 776 episodes were considered appropriate as the hemoglobin levels are less than or equals to 8gm/dl. Hence, a total of 95.2% of transfusion was appropriate.CONCLUSIONS: The overall rate of appropriate PRBC transfusion was quite higher 95.2%. Continuous medical education and practices among doctors and staff can maintain this rate and help in providing quality services to patients.