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Updated: Nov 12, 2025
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Transfusions in patients with iron deficiency anemia following release of Choosing Wisely Guidelines
A Zohaib Siddiqi1, Daniel Grigat2, Shabnam Vatanpour3
1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Insights
Choosing Wisely Canada transfusion guidelines did not significantly reduce potentially avoidable anemia transfusions in Calgary EDs. A slight, non-significant decrease was observed, potentially due to pre-existing trends.
Area of Science:
- Hematology
- Clinical Transfusion Medicine
- Health Services Research
Background:
- In 2016, Choosing Wisely Canada released transfusion guidelines for Iron Deficiency Anemia, based on American Association of Blood Banks recommendations.
- These guidelines aimed to optimize transfusion practices for anemia patients.
Purpose of the Study:
- To evaluate the impact of the Choosing Wisely Canada transfusion guidelines on transfusion rates in Calgary emergency departments (EDs).
- To assess changes in the number of potentially avoidable transfusions before and after guideline implementation.
Main Methods:
- Analysis of 11,786 anemia encounters between January 2014 and December 2019.
- Definition of potentially avoidable transfusion: hemoglobin >70 g/L and patient hemodynamically stable.
- Time-series analysis to examine quarterly changes in total and potentially avoidable transfusion rates pre- and post-guideline release.
Main Results:
- 12.0% (1409/11,786) of encounters received transfusions; 19.9% (281/1409) were potentially avoidable.
- Potentially avoidable transfusion rate decreased from 21.5% pre-intervention to 18.7% post-intervention.
- The quarterly decrease in potentially avoidable transfusions was 0.3%, which was not statistically significant (p=0.06).
Conclusions:
- The Choosing Wisely Canada guidelines and local educational initiatives did not lead to a statistically significant reduction in potentially avoidable transfusions.
- A pre-existing downward trend in transfusion rates may have influenced the observed outcomes.
- Further strategies may be needed to effectively decrease unnecessary transfusions for anemia in the ED setting.
Background:
In 2016, based on recommendations of the American Association of Blood Banks (AABB), Choosing Wisely Canada released transfusion guidelines for patients with Iron Deficiency Anemia. The goal of the present study was to examine the number of transfusions given in Calgary emergency departments (EDs) before and after the release of these guidelines.
Methods:
We analyzed 11,786 anemia encounters from January 2014 to December 2019. A transfusion was considered potentially avoidable if the patient's hemoglobin was > 70 g/L and if the patient was hemodynamically stable. We used time-series analyses to examine change in rate of total and potentially avoidable transfusions quarterly over the total and pre and post intervention periods.
Results:
In total, 1409/11,786 (12.0%) of the encounters received transfusions; 80.0% (1127/1409) were indicated while 19.9% (281/1409) were potentially avoidable. In the pre-intervention period, the rate of potentially avoidable transfusions was 21.5% (133/618) and in the post-intervention period, the rate of potentially avoidable transfusions was 18.7% (148/791). The rate of potentially avoidable transfusions decreased quarterly at a rate of 0.3% which did not reach statistical significance (p = 0.06).
Discussion:
Our data suggest that the number of potentially avoidable transfusions has not decreased since the release of Choosing Wisely Canada guidelines and local educational initiatives. This may be due to the fact that there is a pre-existing down trend in the number of transfusions provided.
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