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Impact of national transfusion indicators on appropriate blood usage in critically ill patients

Santiago Ramón Leal-Noval1, Victoria Arellano-Orden, Antonio Maestre-Romero

  • 1Critical Care Division, Hospital Universitario Virgen del Rocío, Seville, Spain. sramon@cica.es

Transfusion
|March 12, 2011
PubMed

Insights

National blood transfusion indicators (NBTIs) showed variable impact on appropriate blood component use in critical care. Adherence improved for platelet transfusions but remained poor for fresh-frozen plasma, indicating a need for further guideline refinement.

Area of Science:

  • Critical Care Medicine
  • Transfusion Medicine
  • Health Services Research

Background:

  • Assessing the appropriateness of blood component transfusions is crucial in critical care settings.
  • National Blood Transfusion Indicators (NBTIs) were developed to guide transfusion practices for critically ill patients.

Purpose of the Study:

  • To investigate the impact of implementing NBTIs on the appropriate use of blood components in the intensive care unit (ICU).

Main Methods:

  • A prospective, single-center study involving 1808 ICU patients over one year.
  • Four 90-day periods were used: a control period, followed by periods with NBTI introduction and evaluation of early and late impacts.
  • Data collected on transfusions of red blood cells, platelet concentrates, and fresh-frozen plasma.

Main Results:

  • Red blood cell transfusion adherence to NBTIs showed no significant change, with 13% deviation from protocols.
  • Adherence to NBTI guidelines for platelet concentrate transfusions significantly improved from 36% to 52% (p < 0.01).
  • High and stable non-adherence (74%) to NBTI guidelines was observed for fresh-frozen plasma transfusions, often due to absence of severe bleeding.

Conclusions:

  • NBTI guidelines had a variable impact on blood component transfusion appropriateness in critically ill patients.
  • While platelet transfusion adherence improved, significant challenges remain for fresh-frozen plasma and red blood cell transfusions.
  • Further strategies may be needed to optimize NBTI implementation and improve transfusion practices in critical care.
Abstract

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