Critical evaluation of justifications for the transfusion of red blood cells: the reality of a government emergency hospital

Abstract

BackgroundBlood products and derivatives are indispensable resources in medical therapies. However, it is important to note that the number of donations is far from ideal. Despite constant campaign efforts, a deficit of 1 million units is expected by 2030. ObjectivesTo determine the adequacy of the indications for red blood cell transfusion in an emergency hospital in Alagoas.MethodsThis was a cross-sectional observational study conducted at the Alagoas Blood Center. Of a total of 2936 red blood cell transfusion requests in 2009, 334 were randomized and compared with transfusion parameters described in the literature (primary variable). After analysis, the transfusion requests were categorized as adequate, inadequate or inconclusive. This last group included all red blood cell transfusion requests with insufficient clinical information, rendering their classification as adequate or inadequate impossible. The secondary variable involved the reasons for red blood cell transfusion. A 95% confidence interval was used in the statistical analysis. ResultsForty-seven (14.07%) requests were adequate and 30 (8.98%) were inadequate. Most of the requests were classified as inconclusive (76.94%). The main indications for transfusion were upper gastrointestinal bleeding (26.95%), anemia (46.71%), hypovolemia/hypovolemic shock (10.78%) and sepsis/septic shock (3.29%). ConclusionIt was not possible to reach a conclusion on the adequacy of the indication for transfusion in most of the cases. Therefore, it is important to adopt a transfusion protocol, rigorously analyze blood bank requests, to provide awareness campaigns on the rational use of blood and to implement strategies to use blood products more effectively.

Haemovigilance: Role and importance of blood request forms in routine hospital practice.

“…The result of our study is somewhat comparable with two studies done in Pakistan 17 and Brazil 26 , where completely filled BRFs were found to be 12.7% and 14.07% respectively (Table-II The need of required info to be filled completely is very crucial for the sake of time management and controlling work overload in the blood banks. Blood bank staff should be eased out by the physicians as much as possible by providing maximum information.…”

Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

“…In some institutions, up to 76.9% of post-transfusion audit reports found insufficient clinical information to classify transfusions as adequate or not. 8 After reviewing 494 published articles and using the RAND/UCLA appropriateness method to determine the appropriateness of allogeneic red blood cell transfusion, based on its expected impact on the outcomes of 450 stable non-bleeding patients, Shander et al reported that 59% of the red blood cell units transfused were classified as inappropriate. 9 …”

Profile of hemotherapy care and the safety of the transfusion process

“…A high index of inadequacy of indications for BCs was observed, especially for cryoprecipitate and PC, as is the case with other hospitals in the country 10,11 . However, a study 5 points out even higher rates of inadequacy in the indications for PRBC, corresponding to 99% preoperatively, 23% intraoperatively, and 43% postoperatively.…”