Appropriateness of transfusions of red cells, platelets and fresh frozen plasma

Abstract

Objective: To determine how current hospital practice for transfusions of red cells, platelets and fresh frozen plasma conformed with published criteria. Design: Elaboration of criteria for transfusion from a review of the current literature; and analysis of the medical records of patients receiving transfusions of red cells (200), platelets (215), and fresh frozen plasma (260) during defined time periods in 1993. Setting: A large tertiary care teaching hospital. Outcome measures: Inappropriateness rates for transfusion episodes and numbers of individual units of blood products administered. Results: Inappropriateness rates for transfusion episodes and numbers of individual units administered were 16% and 10% for red cells, 13% and 11% for platelets, and 24% and 16% for fresh frozen plasma (31 % and 21% when transfusions for thrombotic thrombocytopenic purpura were excluded). Red cells and fresh frozen plasma were used inappropriately most frequently in association with a surgical procedure; for platelets, it was their use for bleeding. In many of the transfusions deemed inappropriate, deficiencie of red cells, platelets and/or coagulation factors were documented, but the degree of deficiency did not meet the stringent appropriateness criteria. Twentysix transfusions were deemed inappropriate because the indication was not documented in the medical record. Conclusions: Specific problem areas in which blood product use was inappropriate were identified. Guidelines for transfusion appropriateness, education of hospital staff, and a monitoring system to ensure adherence to the guidelines, are required.

Fresh frozen plasma transfusion in critically ill patients*

“…In our study, ICU and surgical teams were just as likely to order inappropriate FFP transfusions. Our findings are consistent with previous research (4,5,6,18,19), including some in the critically ill (20,21). Rao and colleagues (20) found that Ͼ20% of critically ill patients are exposed to FFP and that about 40% had high prothrombin time (twice the normal level) as the sole indication for FFP.…”

“…Because our focus was on patients receiving FFP, we did not review bleeding or invasive procedures among patients who did not receive FFP. Although our results are consistent with others (4,5,6,18,19), they represent practices in one ICU and may not be appropriate for generalization. However, our results are likely to be valid.…”

Critical evaluation of justifications for the transfusion of red blood cells: the reality of a government emergency hospital

“…Their indiscriminate use carries the risk of increased susceptibility to hospital-acquired infections, transmission of infectious diseases, TRALI, increased expenditure and mortality in critically ill patients (3-12) . Several research groups have studied the unnecessary use of blood products (15,16,20-30) . In a study at the Melbourne Royal Hospital, Metz et al observed that 16% of the RBC transfusions were inappropriate.…”

“…In a study at the Melbourne Royal Hospital, Metz et al observed that 16% of the RBC transfusions were inappropriate. Among these, 66 transfusions were considered inappropriate because the physician did not record the indication for transfusion (20) . In our study, 5 requests received by the blood bank did not include an indication.…”

Non-red blood cell transfusion as a risk factor for mortality following percutaneous coronary intervention

“…Despite published guidelines on the use of individual blood products, surveys suggest wide variations in their use [29]. To date, such guidelines have not addressed the use of blood in patients undergoing coronary revascularization who may be at particular risk following transfusion.…”