Transfusing blood safely and appropriately

Murphy, Michael; Waters, Jonathan H.; Wood, Erica M.; Yazer, Mark H.

doi:10.1136/bmj.f4303

Cited by 36 publications

(46 citation statements)

References 36 publications

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“…This can usually be achieved with vitamin K alone • Do not perform serial blood counts on clinically stable patients. Blood counts should be obtained only when there is reason to believe that a new clinically important abnormality will be detected • Do not transfuse O negative blood except to O negative patients and in emergencies to women of child bearing potential with unknown blood group Blood transfusion has long been associated with short and long-term risks that can cause patient harm [9]. Research to improve blood safety and to promote restrictive blood transfusion practices first gained impetus in the 1970s and the 1980s in response to the risk and recognition that hepatitis C and HIV were transmitted by blood transfusion [10].…”

Section: Restrictive Transfusion Practicementioning

confidence: 99%

The scientific basis for patient blood management

Murphy

Goodnough

2015

Transfusion Clinique et Biologique

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Section: Restrictive Transfusion Practicementioning

confidence: 99%

The scientific basis for patient blood management

Murphy

Goodnough

2015

Transfusion Clinique et Biologique

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“…Despite this rolling programme of national audits, around 20% of transfusions continue to fall outside recommended practice [9, 10], consistent with other international experience [1]. Amongst several possibilities, one likely key explanation for this lack of progress is the variable effectiveness of A&F as an intervention.…”

Section: Introductionmentioning

confidence: 76%

“…The most frequently transfused blood component is red cells, but audits of practice continue to document administration of red cells to groups of stable and non-bleeding patients despite the lack of clear evidence of benefit from clinical trials [1, 2]. Unnecessary transfusion exposes patients to risk, well described by haemovigilance systems such as Serious Hazards of Transfusion (SHOT) in UK, with impacts on mortality and morbidity, through errors in administration and processing, transfusion transmitted infections, acute lung injury and circulatory overload [3, 4].…”

Section: Introductionmentioning

confidence: 99%

The evaluation of enhanced feedback interventions to reduce unnecessary blood transfusions (AFFINITIE): protocol for two linked cluster randomised factorial controlled trials

et al. 2017

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BackgroundBlood for transfusion is a frequently used clinical intervention, and is also a costly and limited resource with risks. Many transfusions are given to stable and non-bleeding patients despite no clear evidence of benefit from clinical studies. Audit and feedback (A&F) is widely used to improve the quality of healthcare, including appropriate use of blood. However, its effects are often inconsistent, indicating the need for coordinated research including more head-to-head trials comparing different ways of delivering feedback. A programmatic series of research projects, termed the ‘Audit and Feedback INterventions to Increase evidence-based Transfusion practIcE’ (AFFINITIE) programme, aims to test different ways of developing and delivering feedback within an existing national audit structure.MethodsThe evaluation will comprise two linked 2×2 factorial, cross-sectional cluster-randomised controlled trials. Each trial will estimate the effects of two feedback interventions, ‘enhanced content’ and ‘enhanced follow-on support’, designed in earlier stages of the AFFINITIE programme, compared to current practice. The interventions will be embedded within two rounds of the UK National Comparative Audit of Blood Transfusion (NCABT) focusing on patient blood management in surgery and use of blood transfusions in patients with haematological malignancies. The unit of randomisation will be National Health Service (NHS) trust or health board. Clusters providing care relevant to the audit topics will be randomised following each baseline audit (separately for each trial), with stratification for size (volume of blood transfusions) and region (Regional Transfusion Committee). The primary outcome for each topic will be the proportion of patients receiving a transfusion coded as unnecessary. For each audit topic a linked, mixed-method fidelity assessment and cost-effectiveness analysis will be conducted in parallel to the trial.DiscussionAFFINITIE involves a series of studies to explore how A&F may be refined to change practice including two cluster randomised trials linked to national audits of transfusion practice. The methodology represents a step-wise increment in study design to more fully evaluate the effects of two enhanced feedback interventions on patient- and trust-level clinical, cost, safety and process outcomes.Trial registration http://www.isrctn.com/ISRCTN15490813 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0614-8) contains supplementary material, which is available to authorized users.

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“…Withholding such therapies in the peri-operative period, is also now a standard approach, in the aim to reduce haemorrhagic complications 2. Although complications can and inevitably will occur, within any given treatment population the potential extent of such complications should never be overlooked when decisions are made regarding these treatments.…”

Section: Discussionmentioning

confidence: 99%

A cautionary tale on the use of antiplatelet treatment following TURP

Murray

Gray

2014

BMJ Case Reports

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SUMMARYA pleasant 74-year-old man was discharged home following a complication-free transurethral resection of his prostate (TURP) and successful trial without catheter. Unfortunately, on postoperative day 6, he presented to A&E with chest pain requiring emergency intervention for a confirmed myocardial infarction. A drug-eluting stent was inserted into his right coronary artery and he was started on dual antiplatelet therapy of aspirin and clopidogrel. On day 7, the patient developed significant haematuria requiring transfusion and an obstructive uropathy, requiring an emergency laparotomy and 1 L of organised clot evacuation from his bladder. The dual antiplatelet treatment was restarted on day 4 postlaparotomy, following debate between both the cardiology and urology teams regarding its appropriate reintroduction. On day 7, he was rushed back to the theatre for a re-laparotomy after CT confirmed reaccumulation of clot following an acute deterioration at ward level. The patient made an excellent recovery and was discharged home with regular outpatient follow-up. BACKGROUND

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Transfusing blood safely and appropriately

Cited by 36 publications

References 36 publications

The scientific basis for patient blood management

The scientific basis for patient blood management

The evaluation of enhanced feedback interventions to reduce unnecessary blood transfusions (AFFINITIE): protocol for two linked cluster randomised factorial controlled trials

A cautionary tale on the use of antiplatelet treatment following TURP

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