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Blood transfusion [NG24]

Measuring the use of this guidance

Recommendation: 1.2.2

When using a restrictive red blood cell transfusion threshold, consider a threshold of 70 g/litre and a haemoglobin concentration target of 70–90 g/litre after transfusion.

What was measured: Proportion of adult haematology patients who were anaemic and had no additional risk factors who were transfused when their haemoglobin was 70g/litre or lower.
Data collection end: July 2017
24%
Number that met the criteria: 195 / 815
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients

What was measured: The proportion of people in hospices who had a pre-transfusion haemoglobin above 70g/L.
Data collection end: December 2016
82%
Area covered: UK
Source: Neoh, K.; Gray, R.; Grant-Casey, J.; et al. National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice, Palliative Medicine, 33, 1, 102-108, 2019. https://doi.org/10.1177/0269216318801755


Recommendation: 1.2.3

Consider a red blood cell transfusion threshold of 80 g/litre and a haemoglobin concentration target of 80–100 g/litre after transfusion for patients with acute coronary syndrome.

What was measured: Proportion of adult haematology patients who were anaemic and had cardiovascular disease who were transfused when their haemoglobin was 80g/litre or lower.
Data collection end: July 2017
44%
Number that met the criteria: 32 / 72
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients

What was measured: The proportion of people in hospices with acute coronary syndrome who had a pre-transfusion haemoglobin above 80g/L.
Data collection end: December 2016
32%
Area covered: UK
Source: Neoh, K.; Gray, R.; Grant-Casey, J.; et al. National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice, Palliative Medicine, 33, 1, 102-108, 2019. https://doi.org/10.1177/0269216318801755


Recommendation: 1.2.5

Consider single‑unit red blood cell transfusions for adults (or equivalent volumes calculated based on body weight for children or adults with low body weight) who do not have active bleeding.

What was measured: Proportion of adult haematology inpatients who were given a single unit transfusion.
Data collection end: July 2017
43%
Number that met the criteria: 527 / 1217
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients

What was measured: Proportion of adult haematology outpatients who were given a single unit transfusion.
Data collection end: July 2017
24%
Number that met the criteria: 629 / 2602
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients

What was measured: The proportion of people in hospices who were weighed before transfusion.
Data collection end: December 2016
15%
Number that met the criteria: 68 / 465
Area covered: UK
Source: Neoh, K.; Gray, R.; Grant-Casey, J.; et al. National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice, Palliative Medicine, 33, 1, 102-108, 2019. https://doi.org/10.1177/0269216318801755


Recommendation: 1.2.6

After each single‑unit red blood cell transfusion (or equivalent volumes calculated based on body weight for children or adults with low body weight), clinically reassess and check haemoglobin levels, and give further transfusions if needed.

What was measured: Proportion of patients who had a red blood cell transfusion in a hospice that had their haemoglobin levels measured after each unit transfused.
Data collection end: December 2016
5%
Number that met the criteria: 25 / 465
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Blood Cell Transfusion in Hospices.

What was measured: Proportion of adult haematology inpatients who had their haemoglobin levels measured in between transfused units.
Data collection end: July 2017
12%
Number that met the criteria: 80 / 684
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients

What was measured: Proportion of adult haematology outpatients who had their haemoglobin levels measured in between transfused units.
Data collection end: July 2017
1.3%
Number that met the criteria: 25 / 1941
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients

What was measured: The proportion of people in hospices who had their haemoglobin checked in between units or post-transfusion.
Data collection end: December 2016
28.4%
Number that met the criteria: 122 / 465
Area covered: UK
Source: Neoh, K.; Gray, R.; Grant-Casey, J.; et al. National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice, Palliative Medicine, 33, 1, 102-108, 2019. https://doi.org/10.1177/0269216318801755


Recommendation: 1.3.7

"Do not routinely offer prophylactic platelet transfusions to patients with any of the following: - chronic bone marrow failure - autoimmune thrombocytopenia - heparin‑induced thrombocytopenia - thrombotic thrombocytopenic purpura."

What was measured: Proportion of prophylactic platelet transfusion episodes in adult haematology patients which were given to patients with chronic bone marrow failure.
Data collection end: July 2017
51%
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients


Recommendation: 1.3.9

Do not routinely transfuse more than a single dose of platelets.

What was measured: Proportion of prophylactic platelet transfusions in adult haematology patients which were single units.
Data collection end: July 2017
94%
Number that met the criteria: 1144 / 1218
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients


Recommendation: 1.3.11

Reassess the patient's clinical condition and check their platelet count after each platelet transfusion, and give further doses if needed.

What was measured: Proportion of adult haematology inpatients who had their platelet counts assessed in between transfused units.
Data collection end: July 2017
42%
Number that met the criteria: 38 / 91
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients

What was measured: Proportion of adult haematology day patients who had their platelet counts assessed in between transfused units.
Data collection end: July 2017
19%
Number that met the criteria: 4 / 21
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Cell & Platelet Transfusion in Adult Haematology Patients


Recommendation: 1.7.1

Monitor the patient's condition and vital signs before, during and after blood transfusions, to detect acute transfusion reactions that may need immediate investigation and treatment.

What was measured: The proportion of people in hospices who had clinical observations undertaken, within 15 min of transfusion commencement and at 60 min post-transfusion.
Data collection end: December 2016
95%
Area covered: UK
Source: Neoh, K.; Gray, R.; Grant-Casey, J.; et al. National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice, Palliative Medicine, 33, 1, 102-108, 2019. https://doi.org/10.1177/0269216318801755


Recommendation: 1.8.1

Provide verbal and written information to patients who may have or who have had a transfusion, and their family members or carers (as appropriate), explaining: the reason for the transfusion the risks and benefits the transfusion process any transfusion needs specific to them any alternatives that are available, and how they might reduce their need for a transfusion that they are no longer eligible to donate blood that they are encouraged to ask questions.

What was measured: Proportion of patients who had a red blood cell transfusion in a hospice that had the risks and benefits of transfusion explained.
Data collection end: December 2016
71%
Area covered: UK
Source: NHS Blood and Transplant. National Comparative Audit of Red Blood Cell Transfusion in Hospices.



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