Appropriateness of Blood component transfusion in children in a tertiary care teaching hospital

Aim: The present study aims to assess appropriateness of blood component transfusions in Indian children. material and methods: An observational retrospective done at pediatric department in a tertiary care teaching hospital. All 3 months-12 years old in-patients receiving any blood component were included over a period of 6 months and analyzed for appropriateness of transfusions received as per standard guidelines. results: Total 51 fresh frozen plasma (FFP) transfusions were given in 31 patients of which 28 (55%) were given because of deranged coagulogram without bleeds, 17 (33%) had bleeds and 6 (11.7%) received for other miscellaneous indications. Thirty-nine (76%) FFP transfusions were unjustified. Total 31 platelet transfusions were given in 19 patients of which 16 (51%) were given prophylactically, 14 (45%) received for bleeds and 1 before lumbar puncture. Out of the total 31 platelet transfusions, 8 (26%) were clearly avoidable. Total 138 packed red blood cell transfusions (PRBC) were given in 128 patients of which 123 were given for treatment of anemia (70 in thalassemics and 53 for anemia with varied diagnosis), 6 peri-operatively and 9 with active bleeds. Thirty-six (26%) out of 138 PRBC transfusions were given unnecessarily. conclusion: A large percentage of blood component transfusions (FFP, platelet and PRBC) are given without any definitive indication and are avoidable. There is an urgent need to generate awareness among treating doctors regarding appropriate transfusion practices. introduction Blood components are an important and precious health resource. Transfusion of blood components is an important therapeutic modality and can be life saving in certain circumstances. However, the decision to transfuse blood components is also important as there are significant dangers associated with it. It can lead to several acute and delayed complications and expose the recipient to infectious agents. The inappropriate and unnecessary use of blood and its components exposes the patients to unnecessary risk of these adverse reactions. It also significantly contributes to their increased demand and can lead to their shortage for patients where it is actually required. Thus, it is of utmost importance to reduce the unnecessary transfusions. This can be achieved through the appropriate clinical use of blood, avoiding the need for transfusion and use of alternatives to transfusion. Clinicians should try prevention, early diagnosis and treatment of diseases to avert the need for blood transfusion. The decision to transfuse blood products has to be very cautious in each and every patient and it requires a lot of commitment on the part of health authorities, health care providers and clinicians. There have been previous studies reporting the load of these ‘avoidable transfusions’. The present study assesses the appropriateness of transfusion of various blood components separately in pediatric population in a tertiary care hospital in India. methods & materials The present study was undertaken to assess the appropriateness of transfusion of blood components in pediatric patients in a tertiary care hospital. This was an observational retrospective hospital based study. All pediatric inpatients aged 3 months to 12 years who received any of the blood components over a period of 6 months were included in the study. In our hospital, patients aged >12 years are managed by medicine department and many <3 months kids are managed by neonatology team, hence were excluded for operational reasons. Patient data retrospectively was collected by the chief investigator from the discharge files in order to reduce any bias in decision making regarding the need of blood transfusion. Patient data was collected with respect to the age, sex, diagnosis, indication of transfusion of blood products and pre and post transfusion parameters for the specific type of blood component transfused. Each patient was separately analysed for the appropriateness of transfusions received as per the standard guidelines. An appropriate transfusion is when it is used to treat conditions leading to significant morbidity and mortality that cannot be prevented or managed effectively by other means. (1) Appropriateness of the transfusions given in the present study were assessed by WHO guidelines (1), the British Society for Haematology (BSH) guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant (2), practice guidelines for blood transfusion by American Red Cross (3), BSH guidelines for the use of platelet transfusions (4) and BSH Guidelines for the clinical use of red cell transfusions. (5) results Fresh frozen plasma (FFP) transfusions: A total of 51 fresh frozen plasma (FFP) transfusions were given in 39 patients. Out of 51 transfusions, 28 (55%) were given only because of deranged coagulogram (prolonged PT i.e. prothrombin time and/or prolonged APTT i.e. activated partial prothrombin time) in the absence of any bleeding manifestations. Seventeen (33%) FFP transfusions were given for bleeding manifestations. Out of these 17 FFP transfusions in bleeding patients, 7 (14%) were given empirically in patients with normal or near normal coagulogram. Only 10 (20%) out of 51 FFP transfusions were given because of prolonged PTI and active bleeds. Six patients were transfused FFP because of other miscellaneous conditions. The details of indications for FFP transfusion has been given in table 1. http://www.pediatriconcall. com Pediatric Oncall July September 2015. Volume 12 Issue 3 70 table 1: indications for transfusion of fresh frozen plasma (ffp) number of ffpa trans-fusions (n) primary diagnosis prolonged ptb/ Apttc Bleeding manifestations Any other indication for ffp transfusion Appropriateness 28 deranged coagulogram without bleeds 5 Hepatic encephalopathy Yes No No 8 Viral hepatitis Yes No No 4 Drug induced hepatitis Yes No No 4 Acute meningoencephalitis Yes No No