PTU-258A UK national comparative audit of appropriateness of red cell transfusion in medical patients

IntroductionThe decrease in red cell usage (15%) that has been achieved in recent years has mainly been achieved through the use of blood conservation strategies adopted for surgical patients. Despite national guidelines for blood transfusion being available, agreed triggers for transfusion still need to be established in clinical practice, together with better decision-making in anaemia management to further reduce inappropriate transfusion of red cells in medical patients.MethodsThe main aim of this audit was to observe the extent of inappropriate red cell transfusions, taking account of relevant clinical information and pretransfusion assessment. In autumn 2011, a total of 8759 red cell transfusions in medical units from almost all UK hospitals (>90%) were audited in 3 selected weeks. Through an algorithm based on clinical and diagnostic information provided, a panel of expert physicians estimated the appropriateness of the transfusion. Subgroup analysis was also undertaken to identify patients with a reversible cause of anaemia in whom timely diagnosis and treatment of the original condition would have almost certainly prevented the recourse to blood transfusion.ResultsPreliminary analysis has revealed many cases of red cell transfusion when the pretreatment haemoglobin (Hb) was within acceptable limits. The findings show that 4.1% cases had a pretransfusion Hb higher than 10g/dl (median 7.8, range 2.3-17.7) and 5.8% had a posttransfusion Hb of greater than 12g/dl (median 9.9, range 4.2-19.3). Serum ferritin was measured in only 38% of cases and of these 9.3% of patients had a ferritin