Serpil Vieira Sister Stem Cell Transplant unit

1. Red Cell Transfusion Audit Serpil Vieira Sister Stem Cell Transplant unit

2. Objectives • Review the blood transfusion activity in the unit • Find out where are the gaps and reduce the unnecessary transfusion • Get ready for JACIE

3. Introduction Blood transfusion continues to be an essential part of modern practise but it is not without risk. During the last decade there has been an increased interest across the United Kingdom (UK) and Europe for collecting data on the hazards of transfusion of blood components. Therefore avoiding unnecessary transfusion is accepted as one way of reducing the risk which is associated with blood transfusion. In our stem cell transplant unit we have audited red cell transfusion. The Unit policy is to keep haemoglobin level above 8g/dl, this may change from time to time depending on the patient’s clinical condition.

4. Method The audit was carried out prospectively and retrospectively in two stages. • A “log in” book was kept in the unit for recording the red cell transfusion orders. This part was filled in by nurses who was working on the day. • The data was validated and cross checked retrospectively every two weeks and all inpatient data was recorded on a monthly basis.

5. Method II The audit was carried out over a 17 month period from May 2010 until end of September 2011. The data was divided to two periods and outcome was compared within these two periods. Period I: 01/05/10-31/10/10 - Presented in EBMT 2011 Period II: 01/11/10-30/09/11 - Comparison of these two period is submitted to EBMT 2012

6. Method III We have looked into: • Hg level on the day of transfusion • Reason for transfusion: Bleeding, pre procedure, symptomatic, dr instruction, protocol i.e.thalassamia • How many units of red cell ordered • The consultant who ordered the red cell transfusion

7. Results I - EBMT 2011 Blood transfusion ( Episodes) Period I ( 01/05/10-31/10/10)

8. Results II – EBMT 2011 Reason for Blood Transfusion- Period I ( 01/05/10-31/10/10)

9. Results III – EBMT 2011 • During this 6 months period a total of 90 episodes of RCT were performed in our unit. Haemoglobin levels were 8.5 g/dL or below in 75.5% episodes, where as only 11% of the transfusions performed were when haemoglobin levels were 9.1 g/dL or above. • The reason for transfusion was categorised as: routine, unit protocol, bleeding, pre procedure or doctor’s instruction due to patient symptoms or keeping high haemoglobin thresholds. Routine RCT were 87% of total episodes and 76% of these were 8.5 g/dL or below. However 10% of RCT transfusions were given when haemoglobin levels were 9.1 g/dL or higher

10. Result

11. Future – EBMT 2012? Reason for blood transfusionPeriod I : 01/05/2010- 31/10/10 Period II : 01/11/11- 30/09/10

12. Comparison of Both Periods • During period II (13 months) a total of 240 episodes RCT were given in our unit. In 86.4% of episodes the haemoglobin levels were 8.5 g/dL or below. Where as in 75.5% of episodes in the period I (See Table I), only 8.2% of the transfusion performed were when haemoglobin levels were 9.1g/dL or above. The main reason for the transfusions were when Hg levels > 10.1 g/dL associated with the protocol regarding hyper transfusing beta thalassemia major patients prior to transplant. • The reason for transfusion was categorised: as routine, unit protocol, bleeding, pre procedure and on doctor’s instruction due to patient symptoms or keeping high thresh hold haemoglobin levels. Routine RCT were 52.7% of total episodes in period II, where as in period I, routine transfusions were 22.5% . However 8.2% of the RCT transfusions were given when haemoglobin levels were 9.1 g/dL or higher in period II compared to 10% in period I.

13. Questions?