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How do we reduce plasma transfusion in Rhode Island?

Christian P Nixon1,2, Maria F Tavares3, Joseph D Sweeney1,2,3

  • 1Transfusion Service, Rhode Island Hospital, Providence, Rhode Island.

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|July 7, 2017
PubMed
Summary

Implementing targeted programs significantly reduced plasma transfusions by 77% without impacting patient safety or red blood cell use. This demonstrates effective strategies for optimizing plasma transfusion practices.

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Area of Science:

  • Hematology
  • Transfusion Medicine
  • Healthcare Quality Improvement

Background:

  • Plasma transfusions are critical for coagulopathy, but many prophylactic uses are ineffective.
  • Misdiagnosis of thrombotic thrombocytopenic purpura leads to unnecessary therapeutic plasma exchange.
  • Reducing plasma transfusion is a key goal in transfusion medicine.

Purpose of the Study:

  • To evaluate the impact of a multi-faceted program aimed at reducing plasma transfusion in Rhode Island hospitals.
  • To assess patient safety outcomes associated with decreased plasma transfusion rates.

Main Methods:

  • Initiated programs in three teaching hospitals focused on guidelines, prescriber education, and prescription screening.
  • Implemented an in-house ADAMTS13 assay to improve diagnosis of thrombotic thrombocytopenic purpura.
  • Collected transfusion service and hospital data from 2006 to 2016.

Main Results:

  • Plasma use decreased by 77% (from 11,805 to 2677 units) between 2006 and 2016.
  • This reduction was mirrored statewide and not associated with increased red blood cell transfusion.
  • Inpatient mortality remained unchanged or declined.

Conclusions:

  • Active programs combining education and interdiction can substantially decrease plasma transfusions.
  • These interventions can be implemented without evidence of patient harm.
  • Optimizing plasma transfusion practices improves healthcare quality and resource utilization.