Transfusions in Danish medical patients: adherence to guidelines and effect of interventions

Introduction: The use of blood components per inhabitant in Denmark has for many years been among the highest in the world. The purpose of the present study was to study the indications for red cell transfusions, and the adherence to the Danish National guidelines, in a group of Danish medical patients. Methods: This study was a retrospective, observational study on blood transfusions given at a department of internal medicine. Audit standards were developed from national guidelines. A local campaign consisting of questionnaires, monthly oral status presentations, motivational policy posters, educational sessions, feedback intervention letters, and a compulsory e-learning course was carried out. Results: During 2015, a marked two-third decrease in blood use was observed. In the study period, overall 48% had a recorded valid indication, but only few had anemia-specific symptoms. The combination of a valid indication and a one-unit strategy was only recorded in 31% of transfusions. Overtransfusion occurred frequently. Conclusion: The transfusion practice recorded in this study was mainly in accordance with present guidelines, and reflected the high quality of care given. However, both valid indications and informed consent were lacking in a substantial number of the transfusion episodes. This should be a priority for further action. The study indicates that a combination of focus and educational interventions makes it possible to achieve a considerable reduction in red blood cell transfusions in a mixed medical population.