title: Resource implications of adopting a restrictive neonatal blood transfusion policy.
abstract: BACKGROUND
  Blood transfusions (BTFs) are not without risk and pose a significant financial burden on resource-limited services. In line with current international evidence, the nursery at Groote Schuur Hospital (GSH), Cape Town, South Africa, introduced a restrictive BTF protocol to minimise transfusions and manage costs.
  
  
  OBJECTIVE
  To determine whether adopting a restrictive BTF policy results in fewer transfusions.
  
  
  METHODS
  Data were retrospectively collected on all infants who received BTFs in the GSH nursery over a 6-month period following adoption of a restrictive BTF policy in 2010. BTF figures for a similar time period before the restrictive policy, during 2008, were obtained for comparison.
  
  
  RESULTS
  After introduction of the restrictive BTF policy, 42 of 1 097 infants admitted (3.8%) received a total of 64 BTFs. In comparison, 102 of a total of 940 infants (10.9%) admitted during a period of the same length before introduction of the restrictive BTF policy received a total of 121 transfusions. Comparison between the number of BTFs administered before and after the restrictive policy showed a highly statistically significant difference (p<0.001). The total cost of the blood products used in the two 6-month periods was R91 870 v. R48 640, based on current prices.
  
  
  CONCLUSIONS
  By adopting a restrictive policy, we were able to halve the number of BTFs, reduce risks associated with transfusions, and achieve significant cost benefits. Following evidence-based guidelines results in high standards of care, while also making the most effective use of resources.
authors.affiliation: Neonatal Medicine, Department of Paediatrics, University of Cape Town, South Africa. m.harrison@uct.ac.za.
authors.forename: M C
authors.initials: MC
authors.lastname: Harrison
authors.forename: S
authors.initials: S
authors.lastname: Pillay
authors.forename: Y
authors.initials: Y
authors.lastname: Joolay
authors.forename: N
authors.initials: N
authors.lastname: Rhoda
authors.forename: M S
authors.initials: MS
authors.lastname: Raban
authors.forename: A R
authors.initials: AR
authors.lastname: Horn
authors.forename: L
authors.initials: L
authors.lastname: Tooke
mesh_terms: D000751:Anemia, Neonatal / Q000628:therapy*; D001803:Blood Transfusion / Q000191:economics / Q000379:methods; D003363:Cost Control; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D015276:Health Care Rationing / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D017063:Outcome Assessment, Health Care; D011050:Policy Making; D012189:Retrospective Studies; D013019:South Africa; D065227:Transfusion Reaction