title: Appropriate use of red blood cell transfusion in emergency departments: a study in five emergency departments.
abstract: BACKGROUND
  Transfusion of blood components continues to be an important therapeutic resource into the 21stcentury. Between 5 and 58% of transfusions carried out are estimated to be unnecessary. According to several studies, at least 20% of packed red blood cell transfusions (RBCT) are administered in hospital emergency departments (ED), but few data are available about the appropriateness of RBCT in this setting. This multicentre, cross-sectional observational study aims to assess the appropriateness of RBCT indications and transfused volumes in patients who attend ED.
  
  
  METHODS
  The study cohort is made up of consecutive consenting adult patients (≥18 years old) who received RBCT in ED over a 3-month period and for whom relevant clinical data were collected and analysed.
  
  
  RESULTS
  Data from 908 RBCT episodes (2±1 units per transfused patient) were analysed. RBCT was considered appropriate in 21.4% (n=195), with significant differences according to RBCT indication (p<0.001), hospital level (p<0.001) and prescribing physician (p=0.002). Pre-transfusion haemoglobin level (Hb) negatively correlated with RBCT appropriateness (r=-0.616; p<0.01). Only 72.4% of appropriate RBCT had a post-transfusion Hb assessment (n=516). Of these, 45% were considered to be over-transfused (n=232), with significant differences according to RBCT indication (p=0.012) and prescribing physician (p=0.047). Overall, 584/1,433 (41%) of evaluable RBC units were unnecessarily transfused.
  
  
  CONCLUSIONS
  The appropriateness of RBCT in ED is similar to other hospital departments, but the rate of over-transfusion was high. These data support the need for a reassessment after transfusion of each RBC unit before further units are prescribed. In view of these results, we recommend that physicians should be made more aware of the need to prescribe RBCT appropriately in order to reduce over-transfusion.
authors.affiliation: Emergency Department, La Paz University Hospital, Madrid, Spain.|Department of Medicine, School of Medicine, Madrid Autonomous University, Madrid, Spain.
authors.forename: Manuel Quintana
authors.initials: MQ
authors.lastname: Díaz
authors.affiliation: Department of Clinical Pharmacology, La Paz University Hospital, Madrid, Spain.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Borobia
authors.affiliation: Service of Haematology and Haemotherapy, San Jorge Hospital, Huesca, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: García Erce
authors.affiliation: Emergency Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Charbel
authors.initials: C
authors.lastname: Maroun-Eid
authors.affiliation: Emergency Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Fabra
authors.affiliation: Department of Clinical Pharmacology, La Paz University Hospital, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carcas
authors.affiliation: Department of Clinical Pharmacology, La Paz University Hospital, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Frías
authors.affiliation: Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Malaga, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D017707:Erythrocyte Transfusion / Q000379:methods*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans
chemical_list: D006454:Hemoglobins