Background/Case Studies: The traditional practice of routinely ordering two units of red blood cells (RBC) or platelets has been increasingly questioned in efforts to conserve resources and minimize the risk of adverse transfusion events. The AABB Choosing Wisely campaign advocates for restricting transfusions to only the number of units necessary. It has been shown elsewhere that up to one in four pediatric inpatients received additional transfusions that were considered unnecessary and could have been avoided through clinical reassessment and laboratory testing. At this pediatric hospital we sought to raise awareness and decrease multiple unit transfusions through auditing and education.
Study
Design/Methods: Multiple (RBC/Platelet) transfusion cases were retrospectively reviewed by the transfusion medical director between January 2023 to July 2024 in a pediatric specialty hospital. Each case was assessed by the patient’s clinical status or if transfusion of more than one unit met hospital criteria defined in the standard operating procedures (i.e., bleeding) and was also evaluated to determine whether hemoglobin/hematocrit (H/H) or platelet levels were expected to reach an appropriate threshold after a single-unit transfusion. The review also considered whether administration of additional units could have been avoided if reassessment occurred between transfusions. If it was determined that unnecessary transfusions could have been avoided, the transfusion services sent educational guidance letters to the providers. The data was stratified by component type, year transfused and department (platelet only).
Results/Findings: A total of 156 inpatient records that had pre- and post-transfusion H/H and/or platelet counts performed after all units were transfused were reviewed. The patients received at least 2-unit transfusions (Table 1). Four cases were excluded due to lack of complete data. The rate of nonconformances in the patients who received multi-RBC transfusions decreased by 11% from 2023 to 2024. The rate of nonconformities in patients who received multi-platelet transfusions increased by 24%. When reviewing the platelet transfusion data by department, the inpatient hematology/oncology department noted to have the highest increase. Conclusions: While auditing and provider letters was successful in decreasing multiple unit RBC transfusions, this was not seen with platelet transfusions. Additional measures may be beneficial.
