Evaluating the appropriateness of platelet transfusions compared with evidence‐based platelet guidelines: An audit of platelet transfusions at 57 hospitals

Abstract

Background: Platelet transfusions are used to prevent or control bleeding in patients with thrombocytopenia or platelet dysfunction. The pretransfusion platelet count threshold has been studied extensively in multiple patient settings yielding high-quality evidence that has been summarized in several comprehensive evidence-based platelet guidelines. Study Design and Methods: A prospective 12-week audit of consecutive platelet transfusions using validated and evidence-based adjudication criteria was conducted. Patient demographic, laboratory, and transfusion details were collected with an electronic audit tool. Each order was adjudicated either electronically or independently by two transfusion medicine physicians. The aim was to determine platelet transfusion appropriateness and common scenarios with deviations from guidelines. Results: Fifty-seven (38%) of 150 hospitals provided data on 1903 platelet orders, representing 90% of platelet usage in the region during the time period. Overall, 702 of 1693 adult (41.5%) and 133 of 210 pediatric orders (63.3%) were deemed inappropriate. The most common inappropriate platelet order was for prophylaxis in the absence of bleeding or planned procedure in patients with hypoproliferative thrombocytopenia and a platelet count over 10 x 10 9 /L (53% of inappropriate orders in adults and 45% in pediatrics). Platelet transfusions ordered with either a preprinted transfusion order set (odds ratio [OR],

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

“…In our study, we showed that approximately 56% of all PC transfusions were not compliant with the most recent PC transfusion guidelines [ 2 ]. This percentage is higher than published by authors who showed that 41.5% of adult PC orders were deemed inappropriate [ 21 ]. Reported reasons for overriding blood transfusion guidelines were diverse, including acute bleeding (>34%), protocolized behaviors on specialty services (up to 26%), “symptomatic” anemia (11–12%), anticipated surgical/procedural intervention (10–15%), and imminent hospital discharge (2–5%) [ 22 ].…”

“…In the study by Hill-Strathy et al, the most common clinical scenario where PC transfusion was considered inappropriate (53% of inappropriate orders in adults) was prophylaxis in the absence of bleeding or before the planned procedure in patients with hypo-proliferative thrombocytopenia and a platelet count over 10 × 10 9 /L [ 21 ]. The percentage of inappropriate PC transfusions in our study was much higher than in the population of hematology patients, in whom only 28% of transfusions were performed outside of guidelines [ 23 ].…”

A Clinical Audit of blood component transfusion practices in Paediatric intensive care unit of a Tertiary Care Hospital, Rawalpindi

“…Our study highlighted a significant percent of fresh frozen plasma transfused inappropriately (54%) due to its use as a volume expander and also in the settings of normal coagulation tests, seen similarly in an audit conducted by Wade et al 15 Present study showed platelets to be the most inappropriately transfused component (57%). Widespread platelets as prophylaxis in absence of bleeding attribute to a significant percentage of inappropriate transfusion as concluded by Hill-Strathy et al 16 There is limited data about blood component transfusions audit in children as compared to adults and scarce data is available at the national level. This audit has been conducted only in the paediatric intensive care setting of a tertiary care hospital in a time frame of two months; a larger study population and duration are required to infer better study results.…”

Evaluation of the Appropriateness of Platelet Transfusions at Two Tertiary Hospitals

“…혈소판 수혈은 부족한 혈소판 성분을 보충함으 로써 출혈을 치료(지혈)하고 예방하는 데 그 목적 이 있다. 일반적으로 혈소판 수혈의 가장 흔한 적 응증은 저증식성혈소판감소증(hypoproliferative thrombocytopenia)을 보이는 혈액종양 환자들에서 보 존적 치료 목적의 수혈로 전체 혈소판 수혈 적응 증의 46%에서 77%까지 차지하는 것으로 보고되 었다 [1][2][3]. 최근 혈액종양 환자의 증가와 관련하 여 치료의 강도와 기간의 증가 및 생존률 증가로 갈수록 혈소판제제의 사용량이 증가하고 있는 추 세이다 [4].…”