Changing indications for red cell transfusion from 2000 to 2004 in the North of England

Abstract

Falling donor numbers and the threat of transfusion-transmitted variant Creutzfeldt-Jakob disease may lead to shortages in the national blood supply. Knowledge of current patterns of transfusion and trends in usage will help predict future change in blood use. Our previous survey identified medical indications as the major reason for transfusion, but detailed information within this category was limited. We performed prospective surveys of indications for red cell transfusion for two 14-day periods in 2004 in the North of England, concentrating on medical reasons for transfusion. Data were obtained for transfusion indications of 9003 units, which accounted for over 99% of red cell issues from the regional blood centre during the study. In 2004, medical patients received 62% (5558 units) of all transfused units, surgical patients 33% (3001 units) and Obstetric & Gynaecology patients 5% (444 units). These figures compare with 52, 41 and 6% for Medicine, Surgery, and Obstetrics & Gynaecology in 1999/2000. The three largest uses of blood within the medical category were for patients with primary haematological disorders (18.2% of all transfused blood), for management of gastrointestinal haemorrhage (13.8%) and for patients with nonhaematological malignancies (8.8%). There has been a significant reduction in use of blood for surgical indications over the last 5 years, but an absolute increase in use of blood for medical indications. Lower transfusion triggers, education, use of cell salvage, the increasing price of a unit of red cells and changing population demographics may all have contributed to the reduction in surgical blood use. Promotion of good transfusion practice and alternatives to allogeneic transfusion should now focus on medical and surgical use of blood transfusion.

Utilization of blood and components in a tertiary care hospital

“…The requirement of blood arises more in these cases due to anemia secondary to anorexia, cancer cachexia, bone marrow suppression in cases of leukemias or chemotherapy, etc. Similar high percentage of blood utilization for patients with malignances have been reported in several studies [6,7,11,12].…”

“…Similarly scenatrio has been reported by many workers [12][13][14][15][16]. However, studies like that of Wallis et al have reported more supply to medical patients (62%) as compared to 33% to surgical patients [11].…”

Distribution of indications for blood transfusion among the patients of Faridpur, Bangladesh

“…is result is similar to our study and a study of United Kingdom. 10,11 But, another study from England di ered from these studies showing more surgical cases than medical cases among patients receiving blood transfusions. 12 Results were found di erent in di erent region.…”

“…12 Results were found di erent in di erent region. For example, in case of red cells used in hematology, North England showed 15.5% in 2002 9 , 18.2% in 2006 (excluding iron de ciency anemia) 11 , South-east England showed 13.1% in 2002 12 . Victoria of Australia showed 23.8% in 2009 (including hematinic de ciency, benign and malignant hematology) 13 , South Australia showed 27% (including all hematologic conditions) 10 , and our study (in Faridpur, Bangladesh) showed 37% (including all hematological conditions).…”

The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding

“…A study from the United Kingdom found that this indication alone accounts for 14% of the national red cell supply [11]. There is a widespread variation in clinical practice that influences transfusion threshold, due to several factors including physician, patient factors, and hospital local guidelines.…”