Lab Med Online.  2013 Apr;3(2):97-103.

Evaluation of Changes in Appropriateness of Blood Transfusion in a Tertiary Care Hospital after Advertising the Transfusion Guideline Proposed in 2009

Affiliations
  • 1Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. drwhy@hanmail.net

Abstract

BACKGROUND
In support of safe and appropriate utilization of blood products, the Korean Ministry of Health and Welfare and the Korean Society of Blood Transfusion developed transfusion guidelines in 2009. We evaluated the appropriateness of blood transfusions on the basis of these proposed guidelines.
METHODS
We investigated the awareness of the 2009 proposed guidelines and the transfusion guidelines currently in use through a questionnaire administered to the physicians of a tertiary care hospital. We provided the 2009 proposed transfusion guidelines through summarized pop-ups for each blood product that appeared in the hospital information system whenever a physician ordered blood products, and promoted the guidelines by posting it on the bulletin board and the hospital information system for one month. Evaluation of the appropriateness of blood transfusion was conducted by reviewing the medical records of patients who were transfused within one month before and one month after the promotion. Further, we also examined the rates of blood wastage and return.
RESULTS
Rates of appropriately transfused blood products changed from 29.4% to 33.1% for red blood cells, from 16.9% to 68.9% for platelets, and from 54.8% to 33.3% for fresh frozen plasma. The decreased appropriate transfusion rate of fresh frozen plasma might be due to the small number of transfusions performed during the short study period. The rates of blood wastage and return decreased from 1.77% to 1.21% and from 3.91% to 3.00%, respectively.
CONCLUSIONS
Promotion of the new transfusion guidelines lowered the incidence of inappropriate transfusions. Continuous promotion and establishment of these guidelines after adjustments according to the status of each hospital are necessary.

Keyword

Transfusion; Guidelines; Appropriateness

MeSH Terms

Blood Platelets
Blood Transfusion
Erythrocytes
Hospital Information Systems
Humans
Incidence
Medical Records
Plasma
Surveys and Questionnaires
Tertiary Healthcare

Reference

1. Um TH, Whang DH, Chang YH, Hur M, Kang HJ, editors. Transfusion Guideline. 2009. Seoul: Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention.
2. Liumbruno GM, Rafanelli D. Appropriateness of blood transfusion and physicians' education: a continuous challenge for Hospital Transfusion Committees? Blood Transfus. 2012. 10:1–3.
3. Hessel EA 2nd, Levy JH. Guidelines for perioperative blood transfusion and conservation in cardiac surgery: lessons and challenges. Anesth Analg. 2010. 111:1555–1559.
Article
4. Treleaven J, Gennery A, Marsh J, Norfolk D, Page L, Parker A, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Br J Haematol. 2011. 152:35–51.
Article
5. Westbrook A, Pettila V, Nichol A, Bailey MJ, Syres G, Murray L, et al. Transfusion practice and guidelines in Australian and New Zealand intensive care units. Intensive Care Med. 2010. 36:1138–1146.
Article
6. Roback JD, Caldwell S, Carson J, Davenport R, Drew MJ, Eder A, et al. Evidence-based practice guidelines for plasma transfusion. Transfusion. 2010. 50:1227–1239.
Article
7. Tinmouth AT, Hare GM, Mazer CD. The "sticky" business of "adherence" to transfusion guidelines. Intensive Care Med. 2010. 36:1107–1109.
Article
8. Kim H, Park KU, Han KS. Blood utilization: audit of transfusion practice using an electronic review system. Korean J Blood Transfus. 2010. 21:93–104.
9. Simon TL, Alverson DC, AuBuchon J, Cooper ES, DeChristopher PJ, Glenn GC, et al. Practice parameter for the use of red blood cell transfusions: developed by the Red Blood Cell Administration Practice Guideline Development Task Force of the College of American Pathologists. Arch Pathol Lab Med. 1998. 122:130–138.
10. Vincent JL, Piagnerelli M. Transfusion in the intensive care unit. Crit Care Med. 2006. 34:s96–s101.
Article
11. Hebert PC, Yetisir E, Martin C, Blajchman MA, Wells G, Marshall J, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med. 2001. 29:227–234.
Article
12. Gould S, Cimino MJ, Gerber DR. Packed red blood cell transfusion in the intensive care unit: limitations and consequences. Am J Crit Care. 2007. 16:39–48.
Article
13. Davenport RD. The red blood cell transfusion threshold: evidence and outcome. Curr Hematol Rep. 2002. 1:142–148.
14. Beale E, Zhu J, Chan L, Shulman I, Harwood R, Demetriades D. Blood transfusion in critically injured patients: a prospective study. Injury. 2006. 37:455–465.
Article
15. Chohan SS, McArdle F, McClelland DB, Mackenzie SJ, Walsh TS. Red cell transfusion practice following the transfusion requirements in critical care (TRICC) study: prospective observational cohort study in a large UK intensive care unit. Vox Sang. 2003. 84:211–218.
Article
16. Goodnough LT, Vizmeg K, Riddell J 4th, Soegiarso RW. Discharge haematocrit as clinical indicator for blood transfusion audit in surgery patients. Transfus Med. 1994. 4:35–44.
Article
17. Kim YH, Chung ES, Im SA, Chung RK, Kim SC, Lee ML, et al. Evaluation of the appropriateness of red cells, platelets and fresh frozen plasma utilization. Korean J Lab Med. 2003. 23:448–454.
18. Lawrence JB, Yomtovian RA, Hammons T, Masarik SR, Chongkolwatana V, Creger RJ, et al. Lowering the prophylactic platelet transfusion threshold: a prospective analysis. Leuk Lymphoma. 2001. 41:67–76.
Article
19. Sagmeister M, Oec L, Gmur J. A restrictive platelet transfusion policy allowing long-term support of outpatients with severe aplastic anemia. Blood. 1999. 93:3124–3126.
Article
20. Wandt H, Frank M, Ehninger G, Schneider C, Brack N, Daoud A, et al. Safety and cost effectiveness of a 10×109/L trigger for prophylactic platelet transfusions compared with the traditional 20×109/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia. Blood. 1998. 91:3601–3606.
Article
21. Rebulla P, Finazzi G, Marangoni F, Avvisati G, Gugliotta L, Tognoni G, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. N Engl J Med. 1997. 337:1870–1875.
Article
22. Kang SG, Kwon SW. Analysis of Appropriateness and Efficacy of Fresh Frozen Plasma Transfusion. Korean J Lab Med. 2002. 22:278–285.
23. Metz J, McGrath KM, Copperchini ML, Haeusler M, Haysom HE, Gibson PR, et al. Appropriateness of transfusions of red cells, platelets and fresh frozen plasma. An audit in a tertiary care teaching hospital. Med J Aust. 1995. 162:572–573. 576–577.
24. Novis DA, Renner S, Friedberg R, Walsh MK, Saladino AJ. Quality indicators of blood utilization: three College of American Pathologists Q-Probes studies of 12,288, 404 red blood cell units in 1639 hospitals. Arch Pathol Lab Med. 2002. 02. 126:150–156.
25. Cheema B, Molyneux EM, Emmanuel JC, M'Baya B, Esan M, Kamwendo H, et al. Development and evaluation of a new paediatric blood transfusion protocol for Africa. Transfus Med. 2010. 20:140–151.
Article
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