Evaluating compliance with restrictive blood transfusion practices: A 5-year study from a Greek tertiary hospital

Our aim was to retrospectively assess the adherence to a restrictive transfusion strategy (in the context of patient blood management [PBM]) among patients in a Greek tertiary hospital over a 5-year period (2020-2024) following the initial evaluation of the electronic transfusion request system.

Analyses included assessment of time trends-overall and by hospital clinic-in haemoglobin (Hb) levels at transfusion, as well as in the proportion of inappropriate transfusions, based on pre-specified audit criteria (Hb thresholds for red blood cell transfusions).

A total of 23,322 transfusion episodes were recorded among medical patients, with annual counts ranging from 4078 to 5394 and an overall mean transfusion Hb level of 7.18 ± 0.78 g/dL. The proportion of transfusions with Hb levels above 7.00 g/dL decreased significantly from 69.14% in 2020 to 58.83% in 2023 (Cochran-Armitage test for trend, p < 0.01). Among patients without comorbidities (threshold: 7.00 g/dL), 53.34% of transfusions occurred above this cut-off, with an initial drop from 60.41% in 2020 to 47.72% in 2021, followed by a rebound to 58.43% in 2024 (p = 0.25). Transfusions above 8.00 g/dL also declined significantly, from 8.33% in 2020 to 5.20% in 2023 (p < 0.01). Differences were also observed among clinics.

Overall, moderate compliance with the restrictive transfusion strategy was observed. The initial decline in transfusions above prespecified Hb thresholds followed by fluctuations in subsequent years highlights the need for a consistent, multifaceted effort to optimize blood usage.