Makroo R N, Mani R K, Vimarsh Raina, Kansal Sudha, Pushkar Kumar, Tyagi Sandeep
Departments of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi -110 076, India.
Asian J Transfus Sci. 2009 Jul;3(2):82-5. doi: 10.4103/0973-6247.53879.
The art of fluid administration and hemodynamic support is one of the most challenging aspects of treating critically ill patients. Transfusions of blood products continue to be an important technique for resuscitating patients in the intensive care settings. Concerns about the rate of inappropriate transfusion exist, particularly given the recognized risks of transfusions and the decreasing availability of donor blood. We investigated the current transfusion practice in the critically ill patients at our hospital.
A total of 1817 consecutive critically ill patients admitted between January 2006 and December 2006 were included in this retrospective study. The blood request forms of the patients were analyzed, and their pretransfusion investigations, indications for transfusions, etc. were studied.
Nine hundred and eleven (50.1%) critically ill patients, comprising 71.6% males and 28.4% females, received blood/blood components. About 43.8% patients were administered packed red cells (PRC), 18.27% fresh frozen plasma (FFP) and 8.4% transfused platelets. Among those receiving PRC, 31.1% had a pretransfusion Hb below 7.5g%, 34.4% had Hb between 7.5 and 9g%, while 21.4% had Hb above 9g%. Among those receiving FFP, 14.5% had an international normalized ratio INR < 1.5, and 19% had a pretransfusion platelet count above 50,000/cumm. During the study, there were 7% of the patients who received red cells and FFP, 2% of the patients received red cells and platelets, 1% of the patients received platelets and FFP, and 5% of the patients had received all the three components, i.e., red cells, FFP and Platelets. The baseline investigations and/or clinical indications were not mentioned in 13.1% of patients receiving PRC, 57% receiving FFP and 49.7% receiving platelets.
About 21.4% of PRC, 14.5% of FFP, and 19% of platelets were inappropriately indicated. Clinicians in our centre were conservative in keeping with recent transfusion guidelines. A significant number of blood request forms were still incomplete with baseline investigations not mentioned in the request forms.
液体管理和血流动力学支持技术是治疗重症患者最具挑战性的方面之一。在重症监护环境中，输血仍然是复苏患者的一项重要技术。鉴于输血存在公认的风险以及供血量的减少，人们对不适当输血的发生率表示担忧。我们调查了我院重症患者目前的输血情况。
本回顾性研究纳入了2006年1月至2006年12月期间连续收治的1817例重症患者。分析患者的用血申请单，并研究他们输血前的检查、输血指征等。
911例（50.1%）重症患者接受了血液/血液成分输血，其中男性占71.6%，女性占28.4%。约43.8%的患者输注了浓缩红细胞（PRC），18.27%输注了新鲜冰冻血浆（FFP），8.4%输注了血小板。在接受PRC的患者中，31.1%输血前血红蛋白低于7.5g%，34.4%的血红蛋白在7.5至9g%之间，而21.4%的血红蛋白高于9g%。在接受FFP的患者中，14.5%的国际标准化比值（INR）<1.5，19%输血前血小板计数高于50,000/立方毫米。在研究期间，7%的患者接受了红细胞和FFP，2%的患者接受了红细胞和血小板，1%的患者接受了血小板和FFP，5%的患者接受了所有三种成分，即红细胞、FFP和血小板。在接受PRC的患者中，13.1%未提及基线检查和/或临床指征，接受FFP的患者中有57%未提及，接受血小板的患者中有49.7%未提及。
约21.4%的PRC、14.5%的FFP和19%的血小板存在不适当的输血指征。我们中心的临床医生遵循最近的输血指南，较为保守。大量用血申请单仍然不完整，申请单中未提及基线检查。
