Changing trends in blood transfusion: an analysis of 244,013 hospitalizations

Authors

  • Nadine Shehata,

    Corresponding author
    1. Departments of Medicine and Laboratory Medicine and Pathology, Mount Sinai Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    • Address reprint requests to: Nadine Shehata, MD, Mount Sinai Hospital, 6-502-5, 600 University Avenue Toronto, ON, Canada M5G 1X5; e-mail: nshehata@mtsinai.on.ca.

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  • Alan Forster,

    1. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    2. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Nadine Lawrence,

    1. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Deanna M. Rothwell,

    1. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Dean Fergusson,

    1. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Alan Tinmouth,

    1. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    2. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Kumanan Wilson

    1. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    2. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • NS is a consultant for Canadian Blood Services. Canadian Blood Services did not have a role in the design, analysis, or interpretation of the results.
  • Funded by a Canadian Blood Services' intramural grant XT0085, Canada. NS received support from the Canadian Institute of Health Research/Canadian Blood Services New Investigator Award.

Abstract

Background

Identifying recipients of blood transfusion and the trends in transfusion are needed to properly identify and target clinical services in need of patient blood management strategies. We determined the proportion of admissions to each clinical service that received blood, the mean number of units utilized, and the 5-year trends in utilization.

Study Design and Methods

We used a large administrative database, a repository for three campuses of one university-affiliated hospital, and included all adults that were hospitalized from November 1, 2006, to June 2012. The data were analyzed as the proportion of admissions transfused and the mean number units transfused per admission.

Results

Of 244,013 hospitalizations, 38,265 received at least one transfusion (29,165 for red blood cells [RBCs], 6760 for plasma, and 5795 for platelets [PLTs]). Although there has been a gradual decrease in the mean number of RBCs transfused (percent change, −9.8%; p = 0.002), an increase in the proportion of admissions receiving RBCs (17.2% increase, p < 0.0001) and PLTs (31.5% increase, p < 0.0001) was apparent while there has been a decrease in the proportion of admissions receiving plasma (23.9% decrease, p < 0.0001). Eight percent of cardiology admissions received RBCs, and the highest mean RBC utilization per admission, aside from the stem cell transplantation service, occurred in cardiology and critical care hospitalizations (mean, 4.7 units/hospitalization).

Conclusion

Although there has been a reduction in the mean RBC units used, there has been an increase in the proportion of hospitalizations transfused. A better understanding of the indications for transfusion is required to facilitate the development of targeted blood conservation strategies.

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