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Læknablaðið - 01.01.2014, Qupperneq 17
LÆKNAblaðið 2014/100 17 R A N N S Ó K N ENGLISH SUMMARY introduction: Due to potential risk of blood transfusions, clinical guidelines emphasize restrictive use of blood components. However, numerous studies indicate that adherence to guidelines is often less than optimal. Furthermore, information regarding use of blood transfu- sion in intensive care units (ICUs) and compliance to clinical guidelines is lacking. We studied the use of blood components in two adult ICUs in Iceland and the compliance to clinical guidelines. Materials and methods: All adult patients that received blood compo- nents in both ICUs at Landspitali during 6 months in 2010 were studied. Hematology and coagulation parameters as well as indications for administration were compared with hospital guidelines. Results: 202 patients (34%) received blood components, half of them after surgery. 30% received red-blood cells (RBCs), 18% fresh frozen plasma (FFP) and 9% platelets. The mean hemoglobin value before RBC transfusion was 87 g/L, but in one third of cases it exceeded 100 g/L. FFP was transfused at a normal prothrombin time in 9% of cases. No coagulation parameters were available before transfusion of 5% of FFP. Mean platelet count before transfusion of platelets was 82 x109/L and in 34% of cases it exceeded 100 x109/L. Conclusion: one third of patients received blood components during their ICU stay, most commonly RBCs. At least 6% of RBCs, 14% of FFPs and 33% of platelets were not transfused according to recent guidelines at Landspítali. Although our results are in line with findings of other studies it appears that the use of blood components in Icelandic ICUs can be improved. key words: Blood transfusion, intensive care unit, red blood cells, fresh frozen plasma, platelets, transfusion clinical guidelines. Correspondence: Gísli H. Sigurðsson, gislih@landspitali.is 1Departments of Anaesthesia & Intensive Care and 2Surgery, and 3Blood Bank, Landspítali University Hospital, 4Faculty of Medicine, University of Iceland inappropriate use of blood components in critical care? oddason KE1,2,4, Gudbjartsson T2,4, Gudmundsson S3,4, Karason S1,4, Hreinsson K1, Sigurdsson GH1,4 Heimildir 1. Westbrook A, Pettila V, Nichol A, Bailey MJ, Syres G, Murray L, et al. Transfusion practice and guidelines in Australian and New Zealand intensive care units. Intensive Care Med 2010; 36: 1138-46. 2. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288: 1499-507. 3. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT Study: Anemia and blood transfusion in the critically ill--current clinical practice in the United States. Crit Care Med 2004; 32: 39-52. 4. Napolitano LM, Kurek S, Luchette FA, Anderson GL, Bard MR, Bromberg W, et al. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. J Trauma 2009; 67: 1439-42. 5. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340: 409-17. 6. Sakr Y, Lobo S, Knuepfer S, Esser E, Bauer M, Settmacher U, et al. Anemia and blood transfusion in a surgical intensive care unit. Crit Care 2010; 14: R92. 7. Vlaar AP, in der Maur AL, Binnekade JM, Schultz MJ, Juffermans NP. A survey of physicians’ reasons to trans- fuse plasma and platelets in the critically ill: a prospective single-centre cohort study. Transfus Med 2009; 19: 207-12. 8. Kor DJ, Gajic O. Blood product transfusion in the critical care setting. Curr Opin Crit Care 2010; 16: 309-16. 9. Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2012; 4: CD002042. 10. Ali A, Auvinen MK, Rautonen J. The aging population poses a global challenge for blood services. Transfusion 2010; 50: 584-8. 11. Schofield WN, Rubin GL, Dean MG. Appropriateness of platelet, fresh frozen plasma and cryoprecipitate transfusion in New South Wales public hospitals. Med J Aust 2003; 178: 117-21. 12. Lauzier F, Cook D, Griffith L, Upton J, Crowther M. Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 2007; 35: 1655-9. 13. Hreinsson K. Klínískar leiðbeiningar um notkun blóðhluta á Landspítala. Landspítali, Reykjavík 2012. lsh.is/library/ Sameiginlegar-skrar/Gagnasafn/BRUNNURINN/ Kliniskar-leidbeiningar/Blodhlutar/klin_leid_notkun_ blodhluta_sept_2012.pdf. - janúar 2013. 14. Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet 2013; 381: 1845-54. 15. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008; 36: 2667-74. 16. Sigurdsson GH, Rasmussen LS. Indications for blood transfusion. Are we using the right transfusion trigger? Acta Anaesthesiol Scand 2012; 56: 267-9. 17. NHAMR C. Clinical practice guidelines on the use of blood components (red blood cells, platelets, fresh frozen plasma, cryoprecipitate). Canberra 2001. nhmrc.gov.au/ publications/synopses/cp77syn.htm - október 2010. 18. McGrath T, Koch CG, Xu M, Li L, Mihaljevic T, Figueroa P, et al. Platelet transfusion in cardiac surgery does not confer increased risk for adverse morbid outcomes. Ann Thorac Surg 2008; 86: 543-53. 19. Vamvakas EC, Blajchman MA. Transfusion-related morta- lity: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009; 113: 3406-17. 20. Murthy S, Wunsch H. Clinical review: International comparisons in critical care - lessons learned. Crit Care 2012; 16: 218. 21. French CJ, Bellomo R, Finfer SR, Lipman J, Chapman M, Boyce NW. Appropriateness of red blood cell transfusion in Australasian intensive care practice. Med J Aust 2002; 177: 548-51. 22. Perner A. Preferences for colloid use in Scandinavian intensive care units. Acta Anaesthesiol Scand 2008; 52: 750-8. 23. Chowdary P, Saayman AG, Paulus U, Findlay GP, Collins PW. Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. Br J Haematol 2004; 125: 69-73. 24. Velik-Salchner C, Maier S, Innerhofer P, Kolbitsch C, Streif W, Mittermayr M, et al. An assessment of cardiopulmon- ary bypass-induced changes in platelet function using whole blood and classical light transmission aggrego- metry: the results of a pilot study. Anesth Analg 2009; 108: 1747-54. 25. Wilson K, MacDougall L, Fergusson D, Graham I, Tinmouth A, Hebert PC. The effectiveness of interventions to reduce physician’s levels of inappropriate transfusion: what can be learned from a systematic review of the literature. Transfusion 2002; 42: 1224-9. 26. Brandt MM, Rubinfeld I, Jordan J, Trivedi D, Horst HM. Transfusion insurgency: practice change through educa- tion and evidence-based recommendations. Am J Surg 2009; 197: 279-83. 27. Damiani G, Pinnarelli L, Sommella L, Farelli V, Mele L, Menichella G, et al. Appropriateness of fresh-frozen plasma usage in hospital settings: a meta-analysis of the impact of organizational interventions. Transfusion 2010; 50: 139-44. 28. Rehm JP, Otto PS, West WW, Grange JJ, Halloran BG, Lynch TG, et al. Hospital-wide educational program decreases red blood cell transfusions. J Surg Res 1998; 75: 183-6. 29. Pentti J, Syrjala M, Pettila V. Computerized quality assurance of decisions to transfuse blood components to critically ill patients. Acta Anaesthesiol Scand 2003; 47: 973-8.
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