A Systematic Review and Meta-Analysis of the Clinical Appropriateness of Blood Transfusion in China

Zhu, Changtai; Gao, Yulu; Li, Zhiqiang; Li, Qinyun; Gao, Zongshuai; Liao, Yanqiu; Deng, Zhifeng

doi:10.1097/md.0000000000002164

Cited by 17 publications

(12 citation statements)

References 53 publications

(23 reference statements)

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“…A red blood cell transfusion decision should be made based on the patient’s hemoglobin concentration (Hb) to balance sufficient oxygen supply and transfusion-related reactions. In China, the rate of unnecessary erythrocyte transfusion reached 30.9, 95% CI [confidence interval] = 27.1–35.0% [1] and was 28.8% in our institution; this rate was higher in surgical departments than in other departments [2]. A high number of transfusions are performed without objective indications.…”

Section: Introductionmentioning

confidence: 79%

Continuous noninvasive hemoglobin monitoring estimates timing for detecting anemia better than clinicians: a randomized controlled trial

Tang

et al. 2019

BMC Anesthesiol

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Background Hemoglobin measurement is important for transfusion decision-making. Pulse CO-Oximetry provides real-time continuous hemoglobin (SpHb) monitoring. The triage role of SpHb trends based on hemoglobin measurements was investigated. Methods In this diagnostic randomized controlled trial, 69 patients undergoing spine or cytoreductive surgery were randomly enrolled into SpHb-monitoring and standard-care groups. Diagnostic blood samples were drawn for CO-oximetry Hb (CoOxHb) when the SpHb decreased by 1 g/dl or at the clinician’s discretion in the standard-care group. The positive predictive value (PPV) was defined as the ability to detect a decrease in CoOxHb > 1 g/dl or a CoOxHb < 10 g/dl; the PPVs were compared using Fisher’s exact test. The SpHb and trend accuracies were calculated. The transfusion units and postoperative hemoglobin levels were compared. Results The PPV of a decrease in CoOxHb > 1 g/dl was 93.3% in the SpHb group vs 54.5% without SpHb monitoring ( p = 0.002). The PPV of CoOxHb < 10 g/dl was 86.7% vs. 50.0% for these groups ( p = 0.015). The CoOxHb was never < 7 g/dl with SpHb monitoring. Sixty SpHb–CoOxHb data pairs and 28 delta pairs (ΔSpHb-ΔCoOxHb) were collected. The bias, precision and limits of agreement were − 0.29, 1.03 and − 2.30 to 1.72 g/dl, respectively. When ΔSpHb and ΔCoOxHb were > 1 g/dl, the concordance rate for changes in hemoglobin reached 100%. The delta pairs revealed a positive correlation [ΔSpHb = 0.49 * ΔCoOxHb - 0.13; r = 0.69, 95% confidence interval (0.53, 0.82)]. No significant differences were found in the transfusion volume or postoperative anemia state. Conclusions The SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians. Trial registration ChiCTR1800016290 (Prospective registered). Initial registration date was 24/05/2018.

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Section: Introductionmentioning

confidence: 79%

Continuous noninvasive hemoglobin monitoring estimates timing for detecting anemia better than clinicians: a randomized controlled trial

Tang

et al. 2019

BMC Anesthesiol

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“…of 62.6% [ 25 ] and Zhu et al . of 37.3% [ 69 ], but only 27.8% of recipients received appropriate component transfusions. This was due to the use of whole blood as a sole component for transfusion in resource-limited areas [ 20 , 50 ] and also 97% whole blood transfusion in this study of all patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of recipients’ characteristics, transfusion appropriateness, and utilization pattern of blood and blood products in Jimma Medical Center, Jimma, Ethiopia

2021

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Background As blood transfusion remains life-saving and is being frequently prescribed, a greater number of its practice is unnecessary or inappropriate. This important clinical intervention is reported as one of the five overused medical treatments, with gross over-ordering and whole blood transfusions as the sole component being common in developing countries. Study of recipient’s demographics, clinical conditions, appropriate blood utilization, and continuous clinical audits for quality assurance and service improvement plan are important factors to this practice. This study was designed to assess the recipient’s characteristics, blood type distributions, appropriateness of blood transfusion, and utilization practice of the big medical center. Methods Institution based cross-sectional study was conducted from February 1 to June 30, 2018. Data were collected using a structured data collection format prepared for this study. All transfusion prescriptions were followed from requisition up to completion. Patient’s age, sex, requesting departments, hemodynamics, number and component of units requested and issued, and units transfused were collected. Transfusion appropriateness was assessed by a criterion-based method while blood utilization was calculated. Results A total of 545 units of blood for 425 patients were cross-matched of the 809 units of total blood prescribed. The mean and median age of transfused individuals was found to be 27.47 ±15.28 years and 26 years respectively, and 65.4% females most in reproductive age groups. O and A Rhesus-positive blood types were the two major blood groups observed. Overall 82.1% of transfusions were appropriate; while only 27.8% of patients received appropriate components as 96.5% of individuals received a whole blood transfusion. Significant blood utilization was recorded with a C/T ratio of 1.05, TP% of 100%, and TI of 1.23. Conclusion Much of the transfusion recipients were relatively young aged and females, most in the reproductive age group. Although whole blood was used as a sole component, significant blood transfusion utilization and appropriateness were recorded; while appropriate component transfusion was recorded to be significantly low. Local transfusion guidelines and appropriate component preparation and utilization are required to improve the sub-optimal blood component transfusion practice.

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“…An important secondary reason for preferring packed red cells over whole blood is that the process of packing red cells allows the separation of plasma which can be frozen for clinical use or fractionated to make plasma‐derived products. However, fresh frozen plasma is frequently regarded as the most inappropriately administered blood component and evidence for its use in many settings is lacking . In SSA, evidence concerning indications for using fresh frozen plasma, and clinical experience of its use, are particularly scarce.…”

Section: Discussionmentioning

confidence: 99%

Packed red cells versus whole blood transfusion for severe paediatric anaemia, pregnancy‐related anaemia and obstetric bleeding: an analysis of clinical practice guidelines from sub‐Saharan Africa and evidence underpinning recommendations

Kohli

Bhaumik

Jagadesh

et al. 2018

Tropical Med Int Health

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Objective Blood component transfusion is increasingly promoted in sub‐Saharan Africa (SSA), but is resource‐intensive so whole blood is often used. We examined SSA recommendations about whole blood and packed red cell transfusions for pregnancy‐related bleeding or anaemia, and paediatric anaemia, and evaluated the evidence underpinning these recommendations. Method Relevant SSA guidelines were identified using five electronic databases, websites for SSA Ministries of Health, blood transfusion services and WHO. To facilitate comparisons, indications for transfusing packed red cells or whole blood within these guidelines and reasons given for these recommendations were recorded on a pre‐designed matrix. The AGREE II tool was used to appraise guidelines that gave a reason for recommending either packed red cells or whole blood. We systematically searched MEDLINE, CINAHL, Global Health, Cochrane library and NHSBT Transfusion Evidence Library, using PRISMA guidelines, for clinical studies comparing whole blood with packed red cells or combined blood components in obstetric bleeding or anaemia, or paediatric anaemia. Characteristics and findings of included studies were extracted in a standardised format and narratively summarised. Results 32 English language guidelines from 15 SSA countries mentioned packed red cell or whole blood use for our conditions of interest. Only seven guidelines justified their recommendation for using packed red cells or whole blood. No recommendations or justifications had supporting citations to research evidence. 33 full‐text papers, from 11 234 citations, were reviewed but only one study met our inclusion criteria. This was a single‐centre study in post‐partum haemorrhage. Conclusion Evidence comparing whole blood and packed red cell transfusion for common paediatric and maternal indications is virtually absent in SSA. Therefore, it is unclear whether policies promoting red cells over whole blood transfusion are clinically appropriate. Building a relevant evidence base will help develop effective policies promoting the most appropriate use of blood in African settings.

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A Systematic Review and Meta-Analysis of the Clinical Appropriateness of Blood Transfusion in China

Abstract: Supplemental Digital Content is available in the text

Cited by 17 publications

References 53 publications

Continuous noninvasive hemoglobin monitoring estimates timing for detecting anemia better than clinicians: a randomized controlled trial

Continuous noninvasive hemoglobin monitoring estimates timing for detecting anemia better than clinicians: a randomized controlled trial

Assessment of recipients’ characteristics, transfusion appropriateness, and utilization pattern of blood and blood products in Jimma Medical Center, Jimma, Ethiopia

Packed red cells versus whole blood transfusion for severe paediatric anaemia, pregnancy‐related anaemia and obstetric bleeding: an analysis of clinical practice guidelines from sub‐Saharan Africa and evidence underpinning recommendations

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