Appropriateness of Blood Transfusions

By: Peter Thiel, Alicia Mah, Muhammad Siddiqui, & Christine Lett

Objective: Red blood cell (RBC) transfusions are an important and potentially life-saving intervention in Obstetrics and Gynecology (O&G). However, with limited guidelines outlining appropriate use of RBC transfusions, many clinicians routinely transfuse based solely on low hemoglobin values and habit. Our aim was to assess transfusion practices at a Canadian tertiary care center before and after a hospital-wide blood management educational campaign based on the Choosing Wisely toolkit.

Methods: We conducted a retrospective chart review of all patients who received a red blood cell (RBC) transfusion while admitted under an Obstetrics and Gynecology provider in two 12-month periods - before and after the intervention. The campaign consisted of Grand Rounds presentations, formal and informal teaching, and posters placed around the hospital. Appropriateness was evaluated based on a set of criteria guided by the presence or absence of active bleeding, initial hemoglobin, and the number of units ordered at one time.

Results: The overall rate of RBC transfusion before and after the intervention were 1.8% and 1.2%, respectively (83/4610 and 55/4618). There was a 52% reduction in the total number of RBC units of transfused (229 vs. 111, p<0.001), a 33% reduction in the number of patients transfused (83 vs. 55 p=0.016), and fewer multiple-unit transfusions without reassessment (39 vs. 13, p=0.005). The rate of transfusion appropriateness was low in both the pre- and post-intervention periods (46.5% vs. 50.7%, p=0.59).

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