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

Abstract

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.

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

“…Numerous studies point out that PC or RBC transfusions are performed outside of the recommendations provided in guidelines [ 15 , 20 ]. In our study, we showed that approximately 56% of all PC transfusions were not compliant with the most recent PC transfusion guidelines [ 2 ].…”

“…Due to numerous possible complications, if PC is used outside the recommended indications, patients are put at risk. Poor implementation of blood component transfusion guidelines leads to over-transfusion, as the authors showed in the previous publication regarding red blood cells (RBC) [ 15 ]. Over-transfusion of PC also decreases the availability of this scarce resource, which is particularly important during pandemics when recruitment of donors is compromised, an example being the novel coronavirus disease (COVID-19) pandemic [ 16 ].…”

No bleeding complications during major surgery in a subacute liver dysfunction patient with international normalized ratio in the therapeutic range

“…Transfusion of blood products can lead to numerous complications, the frequency of which depends on the blood product being transfused. These complications comprise febrile non-hemolytic transfusion reactions, acute hemolytic transfusion reactions, nosocomial infections, immunomodulation, transfusion-associated acute lung injury (TRALI), thromboembolic complications, allergic reactions, immunization, and blood-born pathogen transmission [6]. The leading cause of death following transfusion is transfusion-associated circulatory overload [7], particularly following high-volume (standard dose 20 mL/kg) FFP transfusions [8].…”

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

“…The appropriateness of RBC transfusions was decided based on Hb concentration and signs and/or symptoms of anemia before transfusion. Anemia symptoms had to be present before transfusion despite attempts to improve the patient’s tolerance to anemia through increased oxygenation and hemodynamic optimization [ 6 , 7 ]. Increased oxygenation involved oxygen therapy aimed at peripheral oxygen saturation (SpO 2 ) of 100% and/or arterial oxygen saturation (paO 2 ) of 200 mm Hg.…”