Inpatient Blood Transfusion Usage at a Community Veterans Affairs Teaching Hospital
Authors: Huynh Nam , Dayal Sujay , Sama Srikar , Eljabali Aseel , Mahmood Omar , Meyer Wessel , Liman Agnes , Asuncion Alfredo 
Published: December 2024

Inpatient Blood Transfusion Usage at a Community Veterans Affairs Teaching Hospital

Nam Huynh, MD1, Sujay Dayal, MD1, Srikar Sama, MD1, Aseel El-Jabali, MBBS1, Omar Mahmood, MD1,2, Wessel Meyer, MD1,3, Agnes Liman MD4 Alfredo Asuncion, MD4

1 Department of Internal Medicine, University of California San Francisco, Fresno, CA

2 Department of Hematology-Oncology, University of California San Francisco, Fresno, CA

3 Department of Internal Medicine, Fresno Veterans Affairs Medical Center, Fresno, CA

4 Department of Pathology, Fresno Veterans Affairs Medical Center, Fresno, CA

Background

Packed red blood cells (pRBCs) are the primary treatment for various in-hospital conditions. Our hospital blood bank recommends a hemoglobin transfusion threshold of &lt; 7 g/dL for a hemodynamically stable, non-active bleed and &lt; 8 g/dL for patients with cardiovascular risk factors. Currently, we have no protocol to enforce a single-unit transfusion policy. This project aims to understand the current transfusion practice before the implementation of a single-unit transfusion protocol.

Methods

We conducted a retrospective study of all patients, admitted from the emergency department to the medical/surgical ward from January 2023 to December 2023, who required a blood transfusion at the Fresno Veterans Affairs Medical Center. We excluded patients from the Stepdown and Intensive Care units. Data were collected from the local blood bank records of packed red blood cell units transfused. A chart review of the patients' records from 1/2023 to 12/2023 were performed. The number of pRBC units requested, the departments that ordered the transfusions, vital signs, evidence of bleeding, and the number of multi-unit transfusions were recorded. Multi-unit transfusion in our study is defined as more than 1 unit transfusion without a hemoglobin check after the first unit was transfused. The appropriateness criteria for multi-unit transfusion were based on whether patients were stable prior to transfusion and lack of evidence of active bleeding. Patients were considered stable if the systolic blood pressure were above 90 mmHg, resting heart rate &lt;100 beats per minute, pulse oximeter reading &gt;= 90% on room air, or &lt; 2liter increase in oxygen requirement compared to baseline.

Data

On average, our local veteran hospital had a total of 3268 admissions to the medical/surgical wards in 2023. The median age of the patients admitted to our hospital was 72 years, and 96.4% were male. Our blood bank received 113 orders for pRBC transfusions from the medical/surgical ward, and a total of 132 units were utilized. Among the orders for pRBC transfusions, 19 requests were for more than 1 unit at a time. Of those, 63% did not meet the indications for multi-unit transfusion. The emergency department orders for multi-unit transfusion were at the same rate as the medicine ward (50%).

Conclusion

Our study identified characteristics of the current transfusion practice at our local Veterans Affairs hospital. We found that more than half of the multi-unit transfusion requests were not indicated. Future studies will include interventions such as electronic health record clinical decision support systems, education pamphlets, short education sessions for residents, and comparing pre- and post-single unit transfusion guideline implementation and its effects on the utilization of packed red blood cell transfusions at our hospital.