Rational blood transfusion requests in the emergency department

In recent years, the rate of blood transfusion performed in emergency departments (ED) has increased significantly. The aim of this study was to determine the conditions of blood transfusion in ED patients and to identify the causes of unnecessary requests for blood products. The patients older than 18 years old and ordered blood transfusion in Hacettepe University Adult Emergency Department between 01.07.2018 and 01.12.2018, were included in this study. Clinical indications, types and the amount of the blood products that were ordered, transfusion numbers, transfusion/request ratio (TO) and outcomes of 213 patients were recorded. Of our patients, 60.6% were male. The mean age was 58 years. Any kind of bleeding were detected in 53.5% (n = 114) of the patients. Gastrointestinal bleeding was the most commonly clinical diagnosed (n = 49, 23%). The most common indication was symptomatic anemia (n = 70, 22.9%). A total of 1475 units of blood products were requested, consisting 719 units of erythrocyte (ES), 445 units of platelet suspension, 309 units of fresh frozen plasma (FFP) and 2 units of cryoprecipitate. Overall TO ratio (i.e., for all blood products) was found to be 36.9%; 40.8% for ES, 25.6% for platelets and 44.3% for FFP. The threshold of Hb value was 8.85 gr/dl which predicted ES transfusion with sensitivity and specificity levels of 75% and 89.2%, respectively (AUC = 0.858; p <0.001). However, the mean Hb level leading to a decision for transfusion was 9.61 gr/dl ± 3.46. There was a moderately negative and statistically significant correlation between platelet suspension usage rates and plateletcrit (PCT) values. However, no statistically significant correlation was present between FFP usage and platelet numbers, and FFP usage and PCT values. Glasgow-Blatchford scores and ES transfusion rates were significantly correlated in patients with gastrointestinal bleeding (p = 0.003). Mortality ratio was calculated 18.2% (n = 39). In conclusion; in our ED there was an inconsistent of blood products requests and transfusion rates with the international transfusion guidelines as the similar of the literature.