The EASTR Study: indications for transfusion and estimates of transfusion recipient numbers in hospitals supplied by the National Blood Service

Abstract

This study provides data on National Blood Service (NBS) red blood cell (RBC, n = 9142), platelet (PLT, n = 4232) and fresh frozen plasma (FFP, n = 3584) recipients independently sampled by monthly quota from 29 representative hospitals over 12 months in 2001-2002. Hospitals were stratified by size according to total yearly RBC issues. Transfusion indications were chosen from diagnostic and procedural codes, and recipients grouped into Epidemiology and Survival of Transfusion Recipients Case-mix Groups (E-CMGs). The main E-CMGs were digestive [19% of RBC recipients; including 5% gastrointestinal (GI) bleeds and 3% colorectal surgery], musculoskeletal (15%; 12% hip and knee replacement), haematology (13%) and obstetrics and gynaecology (10%). Renal failure, fractured neck of femur, cardiac artery by-pass grafting (CABG) and paediatrics, each accounted for 3-4% recipients. FFP recipients: the main E-CMGs were digestive (21% of FFP recipients; including 7% GI bleeds and 3% colorectal surgery), hepatobiliary (15%; 7% liver disease and 2% liver transplant), cardiac (12%) and paediatrics (9%) The renal, paediatrics, vascular and haematology E-CMGs each had 6-7% of recipients. PLT recipients: the main E-CMGs were haematology (27% of PLT recipients; including 9% lymphoma and 8% acute leukaemia), cardiac (17%), paediatrics (13%), hepatobiliary (10%) and digestive (9%). Back-weighting gave national estimates of 433 000 RBC, 57 500 FFP and 41 500 PLT recipients/year in England and North Wales, median age 69, 64 and 59 years, respectively. Digestive and hepatobiliary indications emerged as the top reason for transfusion in RBC and FFP recipients, and was also a frequent indication in PLT recipients.

The use of fresh‐frozen plasma in England: high levels of inappropriate use in adults and children

“…The main categories of patients receiving FFP in this study appear similar to other studies, although variation exists in the use of FFP among centers within the same country for groups of patients, such as cardiac surgery or critical care 11,12 . In the United Kingdom, an epidemiology study 13 provided the data on FFP recipients over 12 months in 2001 to 2002, indicating that the main recipients were patients with digestive, hepatobiliary, and cardiac symptoms in addition to neonates and children. In a subset of Finnish hospitals, more than 6000 FFP units were tracked to 1159 transfused patients, revealing that FFP was transfused most often in surgical patients, especially cardiac, 14 but unlike our study, that report did not address the intended benefit of FFP use.…”

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

“…Severe bleeding, RBC transfusion and re‐operation are independently associated with organ failure, sepsis and death 3, 4, 5. The provision of RBC and other blood components for cardiac surgery patients also has significant health care costs, and accounts for 10‐15% of the UK blood supply 6, 7…”

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

“…Cardiac surgery is one of the largest single consumers of platelets (17%) produced by NHS Blood and Transplant. 82 Fibrinogen UK guidelines recommend that fibrinogen is replaced during major blood loss or as part of the management of disseminated intravascular coagulation once the Clauss fibrinogen value falls below 1.5 g/l, although this recommendation is based on weak evidence. 86 Cryoprecipitate is the first-line treatment in the UK for acquired hypofibrinogenaemia and a standard adult dose (two pools) raises the plasma fibrinogen level by 1 g/l.…”

“…First, cardiac surgery is a major consumer of blood; up to 35,000 adults undergo complex cardiac surgery in the UK per year, using as much as 5% of all allogenic red cell transfusions. 9,82,120 Second, there is circumstantial evidence suggesting that bleeding and LVBT may be harmful, with observational clinical studies indicating strong associations between transfusion and bleeding and postoperative complications, short and long-term mortality and increased hospitalisation costs. 32,94,167 Third, there is a wealth of evidence suggesting that appropriately targeted blood management strategies may reduce exposure to allogenic blood components.…”