After Hour Blood Transfusions: A Transfusion Service Perspective

Optimal functioning of blood transfusion service during after hours with limited resources are highly challenging. Best transfusion practice guidelines recommends to avoid non-urgent transfusions during out-of-core hours for the concern of patient's safety. This study aimed to evaluate the after hour packed red cell transfusion practice and to identify the proportion of avoidable transfusions in our center. The transfusion requests received, cross-matched and issued between 8 p.m. and 8 a.m. from September 2015 to August 2016 were analysed and categorized into 3E's based on the clinical need as Group I-evident need, Group 2-empirical need and Group 3-elective need. The proportion of avoidable transfusion in each group was noted based on BCSH guidelines on red cell transfusion including the patient's clinical, laboratory parameters and transfusion details. The proportion of PRBC requests received, crossmatched and issued between 8 p.m. and 8 a.m. were 24.45%, 23.84% and 27.15% respectively. The rationale for PRBC transfusion documented for evident, empirical and elective need were 56.95%, 29.34% and 13.71% respectively. Out of which, 19.21% [876/4559] was identified as avoidable transfusions providing no immediate clinical benefit to patients. This study highlights the proportion of avoidable transfusion during after hours in our center and emphasizes the need for transfusion guidelines that recommends to restrict after hour transfusions to those patients with active bleeding or urgent clinical need in order to prevent transfusion related adverse events and improve patient safety.