Czempik Piotr F, Wilczek Dawid, Herzyk Jan, Krzych Łukasz J
Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Transfusion Committee, University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland.
J Clin Med. 2023 Feb 6;12(4):1293. doi: 10.3390/jcm12041293.
In hemodynamically stable patients, both anemia and red blood cell (RBC) transfusion may be detrimental to patients; hence, a decision regarding RBC transfusion should be based on thorough risk-benefit assessment. According to hematology and transfusion medicine organizations, RBC transfusion is indicated when recommended hemoglobin (Hb) triggers are met, and symptoms of anemia are present. The aim of our study was to examine the appropriateness of RBC transfusions in non-bleeding patients at our institution. We performed a retrospective analysis of all RBC transfusions performed between January 2022 and July 2022. The appropriateness of RBC transfusion was based on the most recent Association for the Advancement of Blood and Biotherapies (AABB) guidelines and some additional criteria. The overall incidence of RBC transfusions at our institution was 10.2 per 1000 patient-days. There were 216 (26.1%) RBC units appropriately transfused and 612 (73.9%) RBC units that were transfused with no clear indications. The incidence of appropriate and inappropriate RBC transfusions were 2.6 and 7.5 per 1000 patient-days, respectively. The most frequent clinical situations when RBC transfusion was classified as appropriate were: Hb < 70 g/L plus cognitive problems/headache/dizziness (10.1%), Hb < 60 g/L (5.4%), and Hb < 70 g/L plus dyspnea despite oxygen therapy (4.3%). The most frequent causes of inappropriate RBC transfusions were: no Hb determination pre-RBC transfusion (n = 317) and, among these, RBC transfused as a second unit in a single-transfusion episode (n = 260); absence of anemia sings/symptoms pre-transfusion (n = 179); and Hb concentration ≥80 g/L (n = 80). Although the incidence of RBC transfusions in non-bleeding inpatients in our study was generally low, the majority of RBC transfusions were performed outside recommended indications. Red blood cell transfusions were evaluated as inappropriate mainly due to multiple-unit transfusion episodes, absence of anemia signs and/or symptoms pre- transfusion, and liberal transfusion triggers. There is still the need to educate physicians on appropriate indications for RBC transfusion in non-bleeding patients.
在血流动力学稳定的患者中，贫血和红细胞（RBC）输血都可能对患者有害；因此，关于RBC输血的决定应基于全面的风险效益评估。根据血液学和输血医学组织的建议，当达到推荐的血红蛋白（Hb）触发阈值且存在贫血症状时，才进行RBC输血。我们研究的目的是检查我院非出血患者RBC输血的合理性。我们对2022年1月至2022年7月期间进行的所有RBC输血进行了回顾性分析。RBC输血的合理性基于最新的血液与生物疗法促进协会（AABB）指南以及一些附加标准。我院RBC输血的总体发生率为每1000患者日10.2次。有216个（26.1%）RBC单位输血合理，612个（73.9%）RBC单位输血无明确指征。合理和不合理RBC输血的发生率分别为每1000患者日2.6次和7.5次。RBC输血被归类为合理的最常见临床情况是：Hb < 70 g/L且伴有认知问题/头痛/头晕（10.1%）、Hb < 60 g/L（5.4%）以及Hb < 70 g/L且尽管进行了氧疗仍有呼吸困难（4.3%）。不合理RBC输血的最常见原因是：RBC输血前未测定Hb（n = 317），其中在单次输血事件中作为第二单位输血的RBC（n = 260）；输血前无贫血体征/症状（n = 179）；以及Hb浓度≥80 g/L（n = 80）。尽管我们研究中非出血住院患者的RBC输血发生率总体较低，但大多数RBC输血是在推荐指征之外进行的。红细胞输血被评估为不合理主要是由于多次输血、输血前无贫血体征和/或症状以及宽松的输血触发阈值。仍有必要对医生进行非出血患者RBC输血合适指征方面的教育。
