Monitoring efficacy of transfusion

[Mabel Adams]

An inspector in years past had my current workplace monitor the "efficacy" of transfusions. The procedure includes reviewing charts for expected change in lab values or patient signs & symptoms. Is anyone else doing this and, if so, how do you measure and what do you do with cases that don't seem to be efficacious? Is a policy like this looking for blood product deficiencies, blood administration errors, futile transfusion orders or what? It seems to me that it is so confounded by patient condition that it would be hard to get any actionable data from it.

One useful purpose might be to follow the FFP transfusions of patients with INR of around 1.7 and show that the transfusion did not make an appreciable change in the INR. Can anyone share anything else that is valuable from such effort?

If we are going to expend resources to track something, I want useful, actionable data to come of it.

[David Saikin]

You can only really evaluate the "efficiency" of a transfusion on a non-bleeding pt. I wouldn't do it on someone with a +DAT either (or anyone who appears to be hemolyzing for whatever reason). The pt needs to be hematolgically stable to see the effectiveness of the red cells.

[webersl]

Maybe the inspector was trying to get them to do a "utilization review" and used poor language to describe it. I am not aware of any regulation that insists that you determine the efficacy of transfusion. Isn't that what the FDA (supposedly) and peer reviewed papers are for? Here's what we do for "utilization review" of RBC's. It is retrospective (after the transfusion). We choose a statistically significant number of transfusions to review, and we look at the pre-transfusion hgb. If it was 7 or lower, we are done. We conclude that the utilization of blood was probably appropriate. If it was above 7, we review the chart for any reasons the transfusion may have been deemed appropriate - like the patient was still bleeding. We have a list of reasons that >7 hgb might have warranted a transfusion. If we can't find a good reason, then the Transfusion Committee writes a letter to the ordering physician asking for clarification - and we give a little education on why the transfusion may not have been in the pt's best interest. With the other blood products, we do a concurrent review and do not issue the product if the pt doesn't meet certain criteria. If they still want it, they have to have a discussion with the Medical Director of Transfusion Services - to that is a PROspective review.

[Winter]

"If we can't find a good reason, then the Transfusion Committee writes a letter to the ordering physician asking for clarification - and we give a little education on why the transfusion may not have been in the pt's best interest."

Would you be willing to share the content of the "little education" as well as tips on the best method of presentation?

[David Saikin]

Usually it is the Blood Bank Medical Director who provides the educational opportunity to his peers. They don't want to hear it from me.

[Mabel Adams]

Glad to hear that no one else is looking for efficacy. We have archived the procedure.