Transfusion of blood and its components such as Packed Red Cell (PRC), platelets, and Fresh Frozen Plasma (FFP) play an important role as a supportive therapy in patients admitted to a tertiary care hospital. The inappropriate use of medical technology is a major factor in increased healthcare expenses. This paper reports the results of a cross-sectional study designed to determine the rate of appropriate use of transfusions in a tertiary care hospital in Puducherry, which might lead to the improvement in the transfusion practices.
This was a cross-sectional study which was conducted in a tertiary care center in South India. The information regarding the indication for transfusion was collected from the medical records of the patients who were admitted in our hospital during the study period.
We have analyzed 148 patients who had transfusion during the study period in different departments. A total of 422 transfusions (one unit of blood product was considered as one transfusion) were evaluated in these 148 patients. A review of the patient's medical record was done on each request for a blood and blood component. In this study, the appropriate use of blood and blood components was assessed by NACO guidelines.
Transfusions were evaluated in 148 patients, mean age 40.53 ± 19.36 years. These patients received 422 transfusions (2.17 ± 1.78 transfusions per patient). Of the patients, 28 were from General Medicine, 31 from Cardiology, five from Gastroenterology, 22 from General Surgery, 30 from Obstetrics and Gynaecology, seven from Pediatrics, five from Neurology, and nine from Nephrology and Urology. The overall prevalence of appropriate use was 90% from all departments.
The mean number of transfusions by department was found to be statistically significant in Nephrology and Urology (mean value = 2.08 ± 1.98) and in Gastroenterology (mean value = 2.75 ± 1.39 and P<0.006). The mean number of transfusions in General medicine (2.77 ± 3.02), Cardiology (2.20 ± 1.21), Orthopedics (1.79± 1.02), OBG (1.41 ± 0.74), General Surgery (1.88 ± 1.17), Pediatrics (2.14 ± 1.46), Neurology (4.00 ± 2.93i were not statistically significant.
This audit of transfusions determined that the use of blood and blood components was appropriate in 90% of cases.
In our study, 84 patients were transfused with 144 units of PRC. Of these 144 transfusions, 92% (133/144) belonged to a group of appropriate use. We found a high proportion of appropriate use of PRC. But in contrast to it, Metz et al., found a high proportion of inappropriate use of single-unit transfusions. Grindon et al., pointed out that the presence of a transfusions committee assures consultation in hemotherapy; it evaluates effectiveness of transfusion practices and corrects ineffective practices with respect to blood components.
According to NACO guidelines, this study showed an overall high prevalence of appropriate use of platelets. In our study, we found that 55 transfusions were done for 14 patients. Of these, 93% (51/55) were found to be appropriate. The main indication for the platelet transfusion was to prevent bleeding.
In our study, we found 73% (33/45) of appropriate use of FFP. Percentage of appropriate use of FFP is low compared with other blood products. A coagulation deficiency determination must be performed before requesting FFP. We found unnecessary transfusion of FFP. This must be reduced, because it involves so many risks. Barnette et al., concluded that an educational program may help to reduce the inappropriate use of FFP.
In our study, we found that the use of whole blood is more compared with the blood components (178/422). 91% (162/178) of whole blood transfusions were found to be appropriate. The use of whole blood unnecessarily may lead to volume overload.
This audit has shown that the appropriate use of blood and blood components is about 90%, which is a good rate. The use of whole blood should be reduced to the maximum possible extent so that the cost as well as risk due to blood transfusion can be minimized. Of all blood components, FFP showed a maximum inappropriate usage, which is to be minimized.