Transfusion practice and guidelines in Australian and New Zealand intensive care units
- 613 Downloads
To describe the relationship between clinical practice and national guidelines for the transfusion of red blood cells (RBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate in Australian and New Zealand intensive care units (ICUs).
Forty-seven ICUs over a 5-week period from August to September 2008.
Prospective, observational, multicentre, cohort study.
A total of 874 patients receiving any type of blood transfusion.
All patients who were transfused at least one unit of any blood component were included. Patient-specific and blood-component specific data were gathered. Pre-transfusion haemoglobin, platelet count, international normalised ratio (INR), and fibrinogen levels were compared to national guidelines.
Of all 874 patients, 757 received RBCs (86.6%), 231 (26.4%) received platelets, 340 (38.9%) received FFP, and 78 (8.9%) received cryoprecipitate. Bleeding was the reason for administration of RBCs in 46%, FFP in 55%, and platelets in 47% of transfusions. The mean (SD) pre-transfusion haemoglobin was 77.6 (9.5) g/l, while the geometric means (95% CI) for platelet count, INR, and fibrinogen were 67.0 (59.7–75.3) × 109/l, 1.84 (1.76–1.93), and 1.4 (1.1–1.8) g/l, respectively. The proportions of transfusions not adherent to guidelines were 2% for RBC, but 53% for platelets, 29% for FFP, and 88% for cryoprecipitate (RBC vs. other transfusion p < 0.001 for all).
Transfusion practice of RBCs in Australian and New Zealand ICUs is restrictive and is concordant with guidelines. However, the transfusion of other blood components is not.
KeywordsTransfusion Red blood cells Fresh frozen plasma Platelets Cryoprecipitate Indication
We would like to thank Australian Red Cross Blood Service and the New Zealand Blood Service for excellent collaboration during this study, and the Executive Committee of ANZICS Clinical Trials Group for review and publication endorsement of this study. An unrestricted grant was provided from the Australian Red Cross Blood Service, and the Australian and New Zealand Intensive Care Research Centre.
- 4.(2001) Council NHAMR: Clinical practice guidelines on the use of blood components (red blood cells, platelets, fresh frozen plasma, cryoprecipitate) at http://www.Nhmrc.Gov.Au/publications/synopses/_files/cp78
- 7.(1996) Practice guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on blood component therapy. Anesthesiology 84:732–747Google Scholar
- 8.(2006) Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on perioperative blood transfusion and adjuvant therapies. Anesthesiology 105:198–208Google Scholar
- 10.Welte M (2009) [Erythrocyte transfusion: update of the guidelines “therapy with blood components and plasma derivatives”]. Anaesthesist 58:1150–1158Google Scholar
- 11.Metz J, McGrath KM, Copperchini ML, Haeusler M, Haysom HE, Gibson PR, Millar RJ, Babarczy A, Ferris L, Grigg AP (1995) Appropriateness of transfusions of red cells, platelets and fresh frozen plasma. An audit in a tertiary care teaching hospital. Med J Aust 162: 572–573, 576–577Google Scholar
- 16.Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials group. N Engl J Med 340:409–417CrossRefPubMedGoogle Scholar
- 17.Deans KJ, Minneci PC, Suffredini AF, Danner RL, Hoffman WD, Ciu X, Klein HG, Schechter AN, Banks SM, Eichacker PQ, Natanson C (2007) Randomization in clinical trials of titrated therapies: unintended consequences of using fixed treatment protocols. Crit Care Med 35:1509–1516CrossRefPubMedGoogle Scholar
- 21.Velik-Salchner C, Maier S, Innerhofer P, Kolbitsch C, Streif W, Mittermayr M, Praxmarer M, Fries D (2009) An assessment of cardiopulmonary bypass-induced changes in platelet function using whole blood and classical light transmission aggregometry: the results of a pilot study. Anesth Analg 108:1747–1754CrossRefPubMedGoogle Scholar
- 24.(2003) [Transfusion with fresh frozen plasma: products, indications]. Ann Fr Anesth Reanim 22:252–261Google Scholar
- 25.Expert Working Group (1997) Guidelines for red blood cell and plasma transfusion for adults and children. CMAJ 156 (11 Suppl):S1–S24Google Scholar
- 28.(2003) Guidelines for the use of platelet transfusions. Br J Haematol 122:10–23Google Scholar