A Third of Perioperative Blood Transfusions in the ICU Does Not Follow Guideline Recommendations - A Retrospective Analysis

Objective: This study evaluates the relevance of transfusion guidelines for clinical transfusion practice. Background: There is little data available on current practice related to appropriate use of blood products. Recent data suggest incorrect use and over transfusion in Europe. In Germany, indications for transfusion and administration of blood products are strict and detailed. However, in clinical practice, alignment of transfusion guidelines to clinical situations seems to be difficult for physiciansespecially in complex diseases and severity such as in critical care. We hypothesized that significant practice variability exists with regard to guidelines adherence in critically ill. Materials and methods: Data sets of transfused patients from a surgical intensive care unit of a university center retrospectively were analyzed over a 12 month period. Indications for blood products were compared with guidelines focusing on numbers of ordered and administered units as well as transfusion triggers. Results: In total, during the study period, 450 packed red cells (PRC, 249 orders), 454 fresh frozen plasma (FFP) (201) and 43 platelet units (PC) (29) were given to 89 patients. The mean number of administered PRC was 5.8+/-6.6 (mean +/- SD) units. Double units were administered in 57.4%. Discordant to actual guidelines, 75 (30.12%) PRC`s, 79 (39.30%) FFP's and 9 (31.03%) of PC orders were given without indication. Fresh frozen plasma was administered in ineffective dosage in 83.6% (mean 7.3 ml/kg body weight), platelet transfusion despite intact platelet function in 30.2% and beyond platelet counts of 100 000/μl in 60%. Conclusion: Detailed guidelines for transfusion of blood products were not followed in daily practice in a third of all applications. The reasons for malcompliance are key for improvement.