title: Patterns of blood component use in cirrhosis: a nationwide study.
abstract: OBJECTIVE
  Cirrhosis is a complex acquired disorder of coagulation and frequent indication for transfusion of blood components. We characterised blood component use in patients with cirrhosis and compared this to transfusion guidelines.
  
  
  METHODS
  All National Health Service trusts with representation on the British Society of Gastroenterology membership list were invited to take part. Data were collected prospectively on consecutive, unselected, hospitalised admissions with cirrhosis over 28 days. Detailed information was recorded for patients receiving blood components including indication (for bleeding or prophylaxis), type of component, laboratory indices triggering transfusion, complications, thromboembolic events and clinical outcome to day 28.
  
  
  RESULTS
  Data on 1313 consecutive patients with cirrhosis were collected from 85 hospitals. A total of 391/1313 (30%) were transfused a blood component; in 238/391 (61%), this was for treatment of bleeding and in 153/391 (39%) for prophylaxis of bleeding. In 48/185 (26%) cases with bleeding, the haemoglobin threshold was >80 g/L prior to red blood cell transfusion. In the prophylaxis group, 238/391 (61%) received transfusion in response to an abnormal haematological value in the absence of any planned procedure. In patients transfused for procedural prophylaxis, 10/34 (29%) received fresh frozen plasma at an International Normalised Ratio lower than the threshold where a benefit would be anticipated. An in-patient thromboembolic event was recorded in 3% (35/1313) and 10% (138/1313) died by day 28.
  
  
  CONCLUSIONS
  One-third of hospitalised patients with cirrhosis were transfused. Strategies for Patient Blood Management should include ensuring transfusion practice is consistent with guidelines and greater emphasis on alternatives to transfusion.
authors.affiliation: NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.|Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Michael J R
authors.identifier: http://orcid.org/0000-0002-1951-5616
authors.initials: MJ
authors.lastname: Desborough
authors.affiliation: NHS Blood and Transplant, Sheffield Blood Centre, Sheffield, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Hockley
authors.affiliation: Department of Haematology, Royal Free Hospital, London, UK.
authors.forename: Mallika
authors.initials: M
authors.lastname: Sekhar
authors.affiliation: Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.|University College London Institute of Liver and Digestive Health, University College London, London, UK.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.affiliation: NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Stanworth
authors.affiliation: NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.|Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK.|Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK.
authors.forename: Vipul
authors.initials: V
authors.lastname: Jairath
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000592:standards / Q000639:trends*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013222:State Medicine; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: blood transfusion; cirrhosis; coagulopathy; red blood cells; venous thromboembolism