Evaluation of red blood cell transfusion practices with the use of preset criteria.

OBJECTIVE

To assess current red blood cell (RBC) transfusion practices and to determine the potential impact of implementing recently published guidelines on RBC transfusion from the American College of Physicians (ACP).

DESIGN

Medical chart review.

SETTING

A 219-bed teaching hospital in Kingston, Ont.

PARTICIPANTS

All patients over 12 years of age who received RBC transfusions in March 1992.

MAIN OUTCOME MEASURES

Need for transfusion according to the ACP guidelines and the number of blood units ordered for each transfusion.

RESULTS

A total of 55 patients received 170 RBC units. According to the ACP guidelines 94 (55.3%) of the units were judged unnecessary. The departments of Surgery and Internal Medicine did not differ significantly in the number of unnecessary units (56.4% v. 52.8%). Among the surgical subspecialties, unnecessary transfusion was most common in the orthopedics service (73.5%, p < 0.05). Blood was most frequently ordered 2 units at a time (51.8% of units). Transfusion in normovolemic, hemodynamically stable patients with anemia and unnecessary multiple-unit transfusions were the most common violations of the ACP guidelines.

CONCLUSIONS

According to the ACP guidelines, there was significant unnecessary blood use in the hospital surveyed. The guidelines provide a useful framework for assessing transfusion practices but may require further refinement to apply to a broader spectrum of clinical settings.