Appropriateness of transfusions of red cells, platelets and fresh frozen plasma - An audit in a tertiary care teaching hospital

Objective: To determine how current hospital practice for transfusions of red cells, platelets and fresh frozen plasma conformed with published criteria. Design: Elaboration of criteria for transfusions from a review of the current literature; and analysis of the medical records of patients receiving transfusions of red cells (200), platelets (215), and fresh frozen plasma (260) during defined time periods in 1993. Setting: A large tertiary care teaching hospital. Outcome measures: Inappropriateness rates far transfusion episodes and numbers of individual units of blood products administered. Results: Inappropriateness rates for transfusion episodes and numbers of individual units administered were 16% and 10% for red cells, 13% and 11% for platelets, and 24% and 16% for fresh frozen plasma (31% and 21% when transfusions for thrombotic thrombocytopenic purpura were excluded). Red cells and fresh frozen plasma were used inappropriately most frequently in association with a surgical procedure; for platelets, it was their use for bleeding. In many of the transfusions deemed inappropriate, deficiencies of red cells, platelets and/or coagulation factors were documented, but the degree of deficiency did not meet the stringent appropriateness criteria. Twenty-six transfusions were deemed inappropriate because the indication was not documented in the medical record. Conclusions: Specific problem areas in which blood product use was inappropriate were identified. Guidelines for transfusion appropriateness, education of hospital staff, and a monitoring system to ensure adherence to the guidelines, are required.