Red blood cell transfusion practice in a single institution in Poland in 2018-2019 - Is there room for improvement?

INTRODUCTION

Red blood cell (RBC) transfusion (RBCT) is one of the most frequently performed procedures in inpatients within modern hospital systems. However transfusion practices may vary by an institution or even by a prescribing physician. In order to assess the current RBCT practice in our institution, we performed a detailed analysis of RBCTs.

MATERIAL AND METHODS

We performed a retrospective analysis of all RBCTs in our institution between January 2018 and December 2019. The data collected included: age, sex, type of RBC, number of single and multiple unit RBCTs in bleeding and nonbleeding patients, number of multiple unit RBCTs in non-bleeding patients with and without hemoglobin (Hb) concentration determination after each RBC, primary indication for RBCT, pre-post RBCT Hb concentration in non-bleeding patients, lactate concentration pre-post RBCT in non-bleeding patients.

RESULTS

The indications for RBCT were anemia (2244, 56.2 % RBC) and bleeding (1463, 36.6 % RBC). The most frequently used types of RBCs were RBCs without buffy coat (75.1 %) and leucodepleted RBCs (20.9 %). In non-bleeding patients 45.7 % were multiple unit RBCTs, only 3% were performed with Hb determination following the first unit of RBC, 508 (20.2 %) RBCT were performed with pre-post RBCT lactate concentration determination.

CONCLUSIONS

Analysis of the local RBCT practice showed significant room for improvement. Areas of concern were type of RBC ordered, multiple unit transfusions in non-bleeding patients, lack of laboratory control of oxygenation pre-post transfusion or not taking it into account in RBCT decision making. Deficiencies are planned to be addressed by a comprehensive blood utilization review programme.