Transfusion Review

[NB883]

Is anyone involved in transfusion reviews? If so do you review every transfusion or sample a percentage?

It is very hard to find indications for transfusion. They always state anemia when the hemoglobin is above 8.0

[David Saikin]

I have performed them. The number depends on a lot of things. We review all transfusions for appropriateness, but we only do about 50/month.

[LaraT23]

I am sure you mean below 8, but we have gotten some indicators from several references and use a utilization form that doubles as an order form. It includes the "triggers" for red cell, platelet, FFP and Cryo transfusions to remind the docs. As far as review I print the transfusion report quarterly and go through to find Hgb>8.0, platelet counts >50,000 and INR of less than 2.0. I review these in our computer system to find physician notes as to why the transfusions were done outside of criteria, and those I cannot find any notes for, go to the utilization commitee. Hope that helps.

[Gnapplec]

Just like Lara said above, our order form requires the transfusing facility to give a transfusion indication. This info is also required at issue in our computer so it's easy to pull reports. It's good to see blood utilization is getting more attention.

[Dr. Pepper]

We retrospectivelly audit at least 10% of RBC transfusions (~40-50) and all FFP and platelet/month. Those not meeting criteria go to our medical director (no transfusion committee any more) for chart review. We used to do 100% of red cells, but we'd end up with 30-40 outliers, most of which were deemed justified on chart review, and it was a lot of work for the reviewers. When the committee was disbanded, it fell to me and my chief and we had to cut back to the 10% RBC.

[tbostock]

We prospectively review 100% of our transfusions. We have set criteria and "triggers" that must be met before the blood is released. Any outliers (usually the physician is insisting on giving the blood product outside our criteria) are previewed by the quality department; they pull the chart and look for physician notes that will justify the transfusion. If lacking justification, it goes to Transfusion Committee. Very few, then, need to be reviewed at Transfusion Committee.

[tbostock]

NB883: to the second part of your question, here are the guidelines for transfusion from NY State that we used to come up with our transfusion criteria.

http://www.wadsworth.org/labcert/blood_tissue/blood_services_guideline.htm

[NB883]

We have a place on our form for indications, but the nurse/secretary always write anemia. Even when hgb is well above 8.0. This makes the review very difficult. I was just trying to see if other people were reviewing all transfusions or a percentage. This process takes a few days to review approximately 50 transfusions. Charts are had to find and even harder to read!

[tbostock]

We have a place on our form for indications, but the nurse/secretary always write anemia. Even when hgb is well above 8.0. This makes the review very difficult. I was just trying to see if other people were reviewing all transfusions or a percentage. This process takes a few days to review approximately 50 transfusions. Charts are had to find and even harder to read!

We don't allow this. They would also try to write in "Dr wants it". Have you tried getting support from your Medical Director, or the Transfusion Committee?

[AMcCord]

NB883: to the second part of your question, here are the guidelines for transfusion from NY State that we used to come up with our transfusion criteria.

http://www.wadsworth.org/labcert/blood_tissue/blood_services_guideline.htm

Interesting info - thanks for the link.