Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland

Abstract

BackgroundTransfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland.MethodsIn this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed.Results560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients.ConclusionThis study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

Implementation of a “Patient Blood Management” program in medium sized hospitals: Results of a survey among German hemotherapists

“…Austria and Switzerland implemented at the same time as the German system. 13 However, a recent survey about the implementation of PBM in seven European hospitals participating in the “PBM in Europe” working group of the “European Blood Alliance”—project uncovered significant knowledge gaps and a marginal level of PBM implementation. 3 Participants of the survey by Manzini and colleagues differed, however, from our selection: Members of the PBM European Alliance working group emailed the web‐based form on a SurveyMonkey website to various clinicians in their hospital by an unknown selection mode.…”

“…Austria and Switzerland implemented at the same time as the German system. 13 However, a recent survey about the implementation of PBM in seven European hospitals participating in the "PBM in Europe" working group of the "European Blood…”

“…The Netherlands, Australia, Italy, the UK, France, and Spain started earlier and installed PBM faster than Germany. Austria and Switzerland implemented at the same time as the German system 13 . However, a recent survey about the implementation of PBM in seven European hospitals participating in the “PBM in Europe” working group of the “European Blood Alliance”—project uncovered significant knowledge gaps and a marginal level of PBM implementation 3 .…”

Haemoglobin value and red blood cell transfusions in prolonged weaning from mechanical ventilation: a retrospective observational study

“…The long duration of treatment could also, if perceived by the treating physicians as a failure of the previous therapy, lead them to consider further therapeutic options. Thus, the conscious or unconscious opinion that RBC transfusions might be beneficial for the patient may also play a role, an attitude whose incorrectness still persists among physicians despite growing evidence to the contrary 30 31…”

Haemoglobin thresholds for transfusion: how are we doing in the era of Choosing Wisely? A retrospective cohort study

“…We conducted a retrospective cohort study using data from a high-volume university hospital in Switzerland, which provides care for 44,000 inpatients annually. Clinical coverage is provided by post-graduate medical education trainees (i.e., resident physicians) under the supervision of attending physicians in most units [18]. Therefore, orders for laboratory tests and procedures, such as RBC transfusions, are made at the discretion of the attending physicians or their delegates.…”