Background/Case Studies: The historical practice of routinely ordering two units of red blood cells (RBCs) or platelets has come under scrutiny as part of an effort to conserve blood and reduce the potential for adverse transfusion events. The AABB Choosing Wisely campaign recommends the avoidance of transfusing more units of blood than is absolutely necessary. The objective of this study was to determine if more units of RBCs and platelets than necessary were transfused to the pediatric population of a 137-bed children’s hospital.
Study
Design/Methods: In December of 2022 ordering providers were notified that single-unit RBC and platelet transfusions should be the standard of care for non-bleeding, hospitalized pediatric (< age 18) patients. Additional units should only be prescribed after re-assessment of the patient’s clinical status and their hemoglobin/hematocrit (H/H) or platelet count. Chart audits began in January 2023. Records from January to March 2023 were reviewed. Each case was evaluated by the transfusion service medical director to determine: clinical status of the patient, if transfusion of more than one unit met hospital criteria (i.e., bleeding) defined in standard operating procedures (SOP), if the H/H and/or platelet count was expected to reach an acceptable threshold after transfusion of one unit, and if transfusion of additional units could have been avoided had the patient’s clinical status and post-transfusion H/H and/or platelet counts been evaluated between units.
Results/Findings: All 48 inpatients evaluated had pretransfusion and post-transfusion H/H and/or platelet counts performed after all units were transfused. Patients received 2 or 3 unit transfusions. (Table 1) Conclusions: More than one in four pediatric inpatients evaluated at this hospital during this study received additional transfusions that were deemed unnecessary. These additional transfusions may have been avoided if clinical status had been evaluated and H/H and/or platelet counts were obtained prior to administration of further units. For these patients, letters were sent to ordering providers to offer education regarding the Choosing Wisely campaign and the benefits of single-unit transfusions.
Importance of research: Encourage monitoring of patients with potential to receive more than one unit to determine if additional transfusions are medically necessary.
