THE SINGLE-UNIT BLOOD TRANSFUSION: EXPERIENCE AND IMPACT IN HAEMATOLOGY PATIENTS.
(Abstract release date: 05/21/15)
EHA Library. Allameddine A. 06/12/15; 103211; S139
Disclosure(s): ROYAL OLDHAM HOSPITAL
Allameddine Allameddine
Contributions
Contributions
Abstract
Abstract: S139
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Strauss 1
Background
The Pennine Acute Trust (PAT) is one of the largest non-teaching general hospitals in the UK with an average 30.000 units of blood products are transfused yearly. The Hospital Transfusion Team (HTT) overseeing the transfusion practice, conducted few audits to assess the appropriateness of blood transfusion. These showed that an average of 15-25% of blood transfusion is given inappropriately for various reasons, including the lack of intervention, prevention and diagnosis of anaemia. This has been similarly confirmed by the National Comparative Audits of blood transfusion(1).
Aims
The introduction of the Patient Blood Management (PBM) as a patient-focused model, along with the adoption of a restrictive transfusion triggers, resulted in one of the most effective measures to reduce the inappropriate blood usage, with consequent major benefit for the health care system. The implementation of the single-unit transfusion can considerably reduce the total RBC requirement, as shown in a study of Berger et al (2012), where a change from a double to single-unit transfusion resulted to be safe and achieved a 25% reduction of transfusion requirements(2).
Methods
The HTT introduced the single unit policy for patients without active bleeding in all hospital wards. This involved dispensing one RBC unit at a time. Clinicians were asked to consider each unit transfused as an independent clinical decision and to request the 2nd unit if clinically indicated, after the patient been re-assessed. Recommendations were given to all clinicians to consider alternatives to transfusion, especially, those known with iron deficiency or those with expected transient drop of their haemoglobin level, following treatment, bleeding or sepsis. The main indications suggested for the 2nd unit either the Hb remains<70g/l or patient with on-going chest pain or rise of the haemoglobin less than 8g/l.
Results
The single-unit transfusion policy was introduced in PAT in January 2014. The data analysis within the haematology inpatient ward on the first 12 months of introduction of the policy, and compared with same period of 2013 and matched with the same number of patients, are very encouraging. The analysis revealed an average 31% compliance to single unit policy compared to 10% in 2013. This has resulted in the reduction of the number of RBC units transfused by patient from an average of 3.71 units per patient in 2013 to 3.03 in 2014, with consequent saving of 18% of total units of blood, equivalent to 260 units with a saving of around 40.000 euro/year.
Summary
The introduction of the single unit transfusion policy could result in up to 18% reduction in red blood cell usage in a population with haemato-oncological disorders. These data are very encouraging and demonstrate that the long-standing concept of two RBC units transfusion necessary for an adequate increase of the haemoglobin level must be critically revised. The introduction of this policy will help reducing blood usage, maintain adequate blood supply and optimise healthcare resources. However, further work is needed to improve compliance among clinicians. The introduction of the single unit policy did not have significant impact on the frequency of transfusion. The 72 hours pre-transfusion compatibility specimen expiry allows enough time to consider further transfusion without performing further tests. Although more transfusion events may have occurred in some cases, the overall reduction in transfusion requirement would compensate for the extra work undertaken within the transfusion laboratory.
Keyword(s): Transfusion
Session topic: Red cells: Novel clinical aspects
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Strauss 1
Background
The Pennine Acute Trust (PAT) is one of the largest non-teaching general hospitals in the UK with an average 30.000 units of blood products are transfused yearly. The Hospital Transfusion Team (HTT) overseeing the transfusion practice, conducted few audits to assess the appropriateness of blood transfusion. These showed that an average of 15-25% of blood transfusion is given inappropriately for various reasons, including the lack of intervention, prevention and diagnosis of anaemia. This has been similarly confirmed by the National Comparative Audits of blood transfusion(1).
Aims
The introduction of the Patient Blood Management (PBM) as a patient-focused model, along with the adoption of a restrictive transfusion triggers, resulted in one of the most effective measures to reduce the inappropriate blood usage, with consequent major benefit for the health care system. The implementation of the single-unit transfusion can considerably reduce the total RBC requirement, as shown in a study of Berger et al (2012), where a change from a double to single-unit transfusion resulted to be safe and achieved a 25% reduction of transfusion requirements(2).
Methods
The HTT introduced the single unit policy for patients without active bleeding in all hospital wards. This involved dispensing one RBC unit at a time. Clinicians were asked to consider each unit transfused as an independent clinical decision and to request the 2nd unit if clinically indicated, after the patient been re-assessed. Recommendations were given to all clinicians to consider alternatives to transfusion, especially, those known with iron deficiency or those with expected transient drop of their haemoglobin level, following treatment, bleeding or sepsis. The main indications suggested for the 2nd unit either the Hb remains<70g/l or patient with on-going chest pain or rise of the haemoglobin less than 8g/l.
Results
The single-unit transfusion policy was introduced in PAT in January 2014. The data analysis within the haematology inpatient ward on the first 12 months of introduction of the policy, and compared with same period of 2013 and matched with the same number of patients, are very encouraging. The analysis revealed an average 31% compliance to single unit policy compared to 10% in 2013. This has resulted in the reduction of the number of RBC units transfused by patient from an average of 3.71 units per patient in 2013 to 3.03 in 2014, with consequent saving of 18% of total units of blood, equivalent to 260 units with a saving of around 40.000 euro/year.
Summary
The introduction of the single unit transfusion policy could result in up to 18% reduction in red blood cell usage in a population with haemato-oncological disorders. These data are very encouraging and demonstrate that the long-standing concept of two RBC units transfusion necessary for an adequate increase of the haemoglobin level must be critically revised. The introduction of this policy will help reducing blood usage, maintain adequate blood supply and optimise healthcare resources. However, further work is needed to improve compliance among clinicians. The introduction of the single unit policy did not have significant impact on the frequency of transfusion. The 72 hours pre-transfusion compatibility specimen expiry allows enough time to consider further transfusion without performing further tests. Although more transfusion events may have occurred in some cases, the overall reduction in transfusion requirement would compensate for the extra work undertaken within the transfusion laboratory.
References
1- The National Comparative Audit of Blood Transfusion 2011 Audit of Use of Blood in Adult Medical Patients Part Two July 2013
2- Berger et al, (2012 ) Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation Haematologica. 2012 Jan; 97(1):116-22.
Keyword(s): Transfusion
Session topic: Red cells: Novel clinical aspects
Abstract: S139
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Strauss 1
Background
The Pennine Acute Trust (PAT) is one of the largest non-teaching general hospitals in the UK with an average 30.000 units of blood products are transfused yearly. The Hospital Transfusion Team (HTT) overseeing the transfusion practice, conducted few audits to assess the appropriateness of blood transfusion. These showed that an average of 15-25% of blood transfusion is given inappropriately for various reasons, including the lack of intervention, prevention and diagnosis of anaemia. This has been similarly confirmed by the National Comparative Audits of blood transfusion(1).
Aims
The introduction of the Patient Blood Management (PBM) as a patient-focused model, along with the adoption of a restrictive transfusion triggers, resulted in one of the most effective measures to reduce the inappropriate blood usage, with consequent major benefit for the health care system. The implementation of the single-unit transfusion can considerably reduce the total RBC requirement, as shown in a study of Berger et al (2012), where a change from a double to single-unit transfusion resulted to be safe and achieved a 25% reduction of transfusion requirements(2).
Methods
The HTT introduced the single unit policy for patients without active bleeding in all hospital wards. This involved dispensing one RBC unit at a time. Clinicians were asked to consider each unit transfused as an independent clinical decision and to request the 2nd unit if clinically indicated, after the patient been re-assessed. Recommendations were given to all clinicians to consider alternatives to transfusion, especially, those known with iron deficiency or those with expected transient drop of their haemoglobin level, following treatment, bleeding or sepsis. The main indications suggested for the 2nd unit either the Hb remains<70g/l or patient with on-going chest pain or rise of the haemoglobin less than 8g/l.
Results
The single-unit transfusion policy was introduced in PAT in January 2014. The data analysis within the haematology inpatient ward on the first 12 months of introduction of the policy, and compared with same period of 2013 and matched with the same number of patients, are very encouraging. The analysis revealed an average 31% compliance to single unit policy compared to 10% in 2013. This has resulted in the reduction of the number of RBC units transfused by patient from an average of 3.71 units per patient in 2013 to 3.03 in 2014, with consequent saving of 18% of total units of blood, equivalent to 260 units with a saving of around 40.000 euro/year.
Summary
The introduction of the single unit transfusion policy could result in up to 18% reduction in red blood cell usage in a population with haemato-oncological disorders. These data are very encouraging and demonstrate that the long-standing concept of two RBC units transfusion necessary for an adequate increase of the haemoglobin level must be critically revised. The introduction of this policy will help reducing blood usage, maintain adequate blood supply and optimise healthcare resources. However, further work is needed to improve compliance among clinicians. The introduction of the single unit policy did not have significant impact on the frequency of transfusion. The 72 hours pre-transfusion compatibility specimen expiry allows enough time to consider further transfusion without performing further tests. Although more transfusion events may have occurred in some cases, the overall reduction in transfusion requirement would compensate for the extra work undertaken within the transfusion laboratory.
Keyword(s): Transfusion
Session topic: Red cells: Novel clinical aspects
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Strauss 1
Background
The Pennine Acute Trust (PAT) is one of the largest non-teaching general hospitals in the UK with an average 30.000 units of blood products are transfused yearly. The Hospital Transfusion Team (HTT) overseeing the transfusion practice, conducted few audits to assess the appropriateness of blood transfusion. These showed that an average of 15-25% of blood transfusion is given inappropriately for various reasons, including the lack of intervention, prevention and diagnosis of anaemia. This has been similarly confirmed by the National Comparative Audits of blood transfusion(1).
Aims
The introduction of the Patient Blood Management (PBM) as a patient-focused model, along with the adoption of a restrictive transfusion triggers, resulted in one of the most effective measures to reduce the inappropriate blood usage, with consequent major benefit for the health care system. The implementation of the single-unit transfusion can considerably reduce the total RBC requirement, as shown in a study of Berger et al (2012), where a change from a double to single-unit transfusion resulted to be safe and achieved a 25% reduction of transfusion requirements(2).
Methods
The HTT introduced the single unit policy for patients without active bleeding in all hospital wards. This involved dispensing one RBC unit at a time. Clinicians were asked to consider each unit transfused as an independent clinical decision and to request the 2nd unit if clinically indicated, after the patient been re-assessed. Recommendations were given to all clinicians to consider alternatives to transfusion, especially, those known with iron deficiency or those with expected transient drop of their haemoglobin level, following treatment, bleeding or sepsis. The main indications suggested for the 2nd unit either the Hb remains<70g/l or patient with on-going chest pain or rise of the haemoglobin less than 8g/l.
Results
The single-unit transfusion policy was introduced in PAT in January 2014. The data analysis within the haematology inpatient ward on the first 12 months of introduction of the policy, and compared with same period of 2013 and matched with the same number of patients, are very encouraging. The analysis revealed an average 31% compliance to single unit policy compared to 10% in 2013. This has resulted in the reduction of the number of RBC units transfused by patient from an average of 3.71 units per patient in 2013 to 3.03 in 2014, with consequent saving of 18% of total units of blood, equivalent to 260 units with a saving of around 40.000 euro/year.
Summary
The introduction of the single unit transfusion policy could result in up to 18% reduction in red blood cell usage in a population with haemato-oncological disorders. These data are very encouraging and demonstrate that the long-standing concept of two RBC units transfusion necessary for an adequate increase of the haemoglobin level must be critically revised. The introduction of this policy will help reducing blood usage, maintain adequate blood supply and optimise healthcare resources. However, further work is needed to improve compliance among clinicians. The introduction of the single unit policy did not have significant impact on the frequency of transfusion. The 72 hours pre-transfusion compatibility specimen expiry allows enough time to consider further transfusion without performing further tests. Although more transfusion events may have occurred in some cases, the overall reduction in transfusion requirement would compensate for the extra work undertaken within the transfusion laboratory.
References
1- The National Comparative Audit of Blood Transfusion 2011 Audit of Use of Blood in Adult Medical Patients Part Two July 2013
2- Berger et al, (2012 ) Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation Haematologica. 2012 Jan; 97(1):116-22.
Keyword(s): Transfusion
Session topic: Red cells: Novel clinical aspects
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