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 publis hed criteria. Design: Elaboration of criteria for transfusion from a r eview of the current literature; and analysis of the medical records o f patients receiving transfusions of red cells (200), platelets (215), and fresh frozen plasma (260) during defined time periods in 1993. Se tting: A large tertiary care teaching hospital. Outcome measures: Inap propriateness rates for transfusion episodes and numbers of individual units of blood products administered. Results: Inappropriateness rate s for transfusion episodes and numbers of individual units administere d were 16% and 10% for red cells, 13% and 11% for platelets, and 24% a nd 16% for fresh frozen plasma (31% and 21% when transfusions for thro mbotic thrombocytopenic purpura were excluded). Red cells and fresh fr ozen plasma were used inappropriately most frequently in association w ith a surgical procedure; for platelets, it was their use for bleeding . In many of the transfusions deemed inappropriate, deficiencies of re d cells, platelets and/or coagulation factors were documented, but the degree of deficiency did not meet the stringent appropriateness crite ria. Twenty-six transfusions were deemed inappropriate because the ind ication was not documented in the medical record.Conclusions: Specific problem areas in which blood product use was inappropriate mere ident ified. Guidelines for transfusion appropriateness, education of hospit al staff, and a monitoring system to ensure adherence to the guideline s, are required.