Clinical epidemiology of transfusion medicine

Red blood cell transfusion at Ullevål University Hospital--indications, consumption and blood group immunisation

BACKGROUND

Knowledge of clinical transfusion practice should be improved to ensure that therapy is optimally effective, to avoid waste of resources and to ensure a safe supply of blood.

MATERIAL AND METHOD

All patients who received a transfusion of red blood cell concentrate at Ullevål University Hospital in two 14-day periods in 2003 were included. Diagnoses, haemoglobin values and intervention codes were recorded from the patient records for which consent to access had been given. Blood samples were taken from consenting survivors to be tested for blood group immunisation.

RESULTS

348 patients were included. The median age was 62.8 years. They were given 1,162 concentrates in 471 transfusion episodes, of which 373 (79 %) consisted of one or two concentrates. As at 1 February 2009, 181 patients (52 %) were registered as having died. Access was possible to the records of 218 patients. The primary diagnosis was cancer for 76 patients (35 %), injuries for 36 (17 %) and cardiovascular disease for 34 (16 %). The transfusion was given to 89 (41 %) of patients in connection with a surgical intervention during the period covered by the patient records. A note about the transfusion was lacking in 46 (21 %) of the records. Transfusions were given to 52 patients whose haemoglobin concentration was above a threshold level of ≥ 8 g/100 ml (43 % of the patients). Blood group immunisation was found in one (3 %) of 38 survivors.

INTERPRETATION

Red blood cell transfusion is most commonly given to elderly patients with chronic disorders and uncertain long-term prognoses. The clinical documentation is not infrequently incomplete. There is probably scope for a reduction in consumption if indications are based more on established scientific evidence and well-defined transfusion protocols. Blood group immunisation is not a frequent complication.

Concentration of transfusion resources on a few pathologies and a few patients: analysis of the comprehensive in-hospital patient database

BACKGROUND

Blood is a sparse commodity. Transfusion needs increase while the number of donors decreases. These constraints incite Belgian authorities to pay more attention to transfusion financing. This implies pathologic knowledge of the epidemiology of in-hospital transfusion and the consumption of blood products.

STUDY DESIGN AND METHODS

This study is a retrospective analysis of in-hospital stays from the year 2000 and includes data from all 124 Belgian hospitals. The database contains information on diagnoses, procedures, and all-patients refined diagnosis-related groups (APRDRGs) but also on expenses linked to blood products transfused and to transfusion-related pharmaceutical products.

RESULTS

Three percent of surgical patients used 55.7 percent of transfusion resources and 75.4 percent of transfusion costs were associated with 24 APRDRGs. In the medical group, 3 percent of the patients accounted for 80.2 percent of transfusion costs and 20 APRDRGs consumed 71.9 percent of transfusion resources. The variables with the highest impact on the proportion of patients transfused were severity, pathology, and age. The effect of hospitals remained significant but had less impact. No substitution of blood products by transfusion-related pharmaceutical products was observed in our analysis.

CONCLUSION

Our study confirms that transfusion now centers on a limited number of pathologic entities and, within those, in small subsets of patients. This implies that the costs linked to setting up and running the transfusion system can no longer be shared by a large number of patients who receive transfusions but rely increasingly on patients at higher risks of more unpredictable needs. The system must nevertheless be able to cope with them at any time.

Current issues in transfusion medicine in Norway

Important current issues in transfusion medicine in Norway are discussed. Current patient legislation specifically defines blood donors as patients, and blood and blood products are defined as drugs. Donor selection is controversial, especially deferral of all persons born in, or having lived for more than one year in areas with high prevalence of infections that are transmitted by blood. The threshold for becoming a blood donor is high, but registered donors donate frequently, e.g. 2,4 whole blood donations per year on average. Some blood banks have specialized in multicomponent aphereis technology, in particular collection of two units of red cells.