Hamad Medical Corporation BANGALORE, Karnataka, India
Background/Case Studies: Regular Auditing is an essential pre-requisite in the review and update of Packed Red Blood Cell (PRBC) transfusion practices. Although standard guidelines on appropriate utilization of PRBC exist, erroneous use of blood components with no justification continues.This study evaluates the appropriateness of PRBC transfusion in a Private Super Specialty hospital in South India and identifies key areas requiring educational intervention to improve PRBC transfusion practice toward evidence-based at our hospital.
Study
Design/Methods: This was a retrospective, observational study conducted in the Blood Centre at a Private Super Specialty hospital from May 2023 to October 2023. An audit of all the blood requisition forms against which the PRBC was issued and transfused, across various clinical departments was performed. The request forms were evaluated for the parameters like Indication for the PRBC transfusion and the Pre-transfusion Hemoglobin (Hb). The appropriateness of PRBC utilization was assessed against the recommended guidelines in “Good Blood Transfusion Practices Guidance- Guidance for Rational use of Blood” by Ministry of Health & Family Welfare, Government of India, 2022. Transfusion was considered appropriate if any one of following criteria was present: Hemoglobin < 8 g/dl Hemoglobin >8 g/dl with signs and symptoms such as pallor, fatigue, breathlessness, and tachycardia Hemoglobin >8 g/dl with comorbidities such as cardiovascular disease, angina, shock, and hemolysis Hemoglobin >8 g/dl with imminent bleeding such as surgery, delivery, active bleeding, and bone marrow failure.
If none of above criteria was fulfilled, then transfusion was considered as ‘inappropriate.”
Results/Findings: This study included 398 patients who had RBC transfusion during the defined study period from May 2023 to October 2023, in different departments, with the maximum being in cardiac surgery (71) and the minimum in Obstetrics and gynecology (5). A total of 189 (47.5%) patients had PRBC Transfusions done at Hb < 8g/dl across the departments and a total of 209 (52.51%) patients had PRBC transfusions with Hb >8g/dl, the majority including Surgical departments like Cardiac surgery, Gastric Surgery, Liver transplant, Nephrology, Orthopedics, and Obstetrics & Gynecology. Among Non-surgical departments, like Internal medicine and Respiratory medicine, PRBC transfusions were done at Hb< 8g/dl in 35 (81.4%) and 7 (87.5%) patients respectively. Conclusions: Clinical use of RBC in a super-specialty hospital was largely appropriate. This “appropriate use” may further be enhanced by formulating hospital-specific guidelines and education of physicians.
