Red cell & platelet transfusion in adult haematology patient 2016

Aims

  • Collect information on the context in which care was delivered through the use of an organisational questionnaire
  • Identify variation in practice and compare practice against guidelines
  • Examine the use of red cells and platelets in a sample of patients who had a known haematological condition

Who did we audit?

  • Adults (16 years or over), with a malignant haematological diagnosis or bone marrow failure who received red cells, or platelets, or both in January 2016

Who took part?

  • Organisational audit: 151 hospitals

  • Clinical audit:
    • 170 sites
    • 4649 patients
    • 6109 transfusion episodes (4328 red cell transfusions and 1781 platelet transfusions). 

What did we find?

Recommendations

For improving local guidelines
  • Local hospital guidelines must be easily available and reflect national guidelines for blood transfusion.
  • Local hospital guidelines should state that prophylactic platelet transfusions are not required:Local hospital guidelines should state how to manage transfusions in patients at high risk of Transfusion Associated Circulatory Overload (TACO)
    • Prior to bone marrow aspirates and trephine
    • In stable patients with chronic bone marrow failure
For local audit
  • Information technology solutions are required to allow regular non-labour intensive audit of transfusion practice.
For improving clinical practice
  • The reason for transfusion should be clearly documented in the patient’s record including any individual threshold agreed for that patient
  • In the absence of active bleeding use the minimum number of red cell units required to achieve target haemoglobin and consider a single unit transfusion
  • One adult therapeutic dose of platelets is required for prophylaxis. Pre-procedure consider the size of the patient, previous platelet count increments and the target platelet count.
  • Risk assess the patient for transfusion-associated circulatory overload (TACO) which is the transfusion reaction most commonly associated with death
To help improve practice
Report

Please cite as:

The Haematology Audit Working Group, on behalf of the National Comparative Audit in Blood Transfusion (NCABT) Steering Group. The 2016 audit of red cell & platelet transfusion in adult haematology patients (2017).

Tools