Skip to main content

Advertisement

SpringerLink
Log in

Transfusion practice and guidelines in Australian and New Zealand intensive care units

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To describe the relationship between clinical practice and national guidelines for the transfusion of red blood cells (RBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate in Australian and New Zealand intensive care units (ICUs).

Setting

Forty-seven ICUs over a 5-week period from August to September 2008.

Design

Prospective, observational, multicentre, cohort study.

Patients

A total of 874 patients receiving any type of blood transfusion.

Methods

All patients who were transfused at least one unit of any blood component were included. Patient-specific and blood-component specific data were gathered. Pre-transfusion haemoglobin, platelet count, international normalised ratio (INR), and fibrinogen levels were compared to national guidelines.

Results

Of all 874 patients, 757 received RBCs (86.6%), 231 (26.4%) received platelets, 340 (38.9%) received FFP, and 78 (8.9%) received cryoprecipitate. Bleeding was the reason for administration of RBCs in 46%, FFP in 55%, and platelets in 47% of transfusions. The mean (SD) pre-transfusion haemoglobin was 77.6 (9.5) g/l, while the geometric means (95% CI) for platelet count, INR, and fibrinogen were 67.0 (59.7–75.3) × 109/l, 1.84 (1.76–1.93), and 1.4 (1.1–1.8) g/l, respectively. The proportions of transfusions not adherent to guidelines were 2% for RBC, but 53% for platelets, 29% for FFP, and 88% for cryoprecipitate (RBC vs. other transfusion p < 0.001 for all).

Conclusions

Transfusion practice of RBCs in Australian and New Zealand ICUs is restrictive and is concordant with guidelines. However, the transfusion of other blood components is not.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Marik PE, Corwin HL (2008) Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 36:2667–2674

    Article  PubMed  Google Scholar 

  2. Vamvakas EC, Blajchman MA (2009) Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 113:3406–3417

    Article  CAS  PubMed  Google Scholar 

  3. Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB, Hubmayr RD, Gajic O (2007) Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 131:1308–1314

    Article  PubMed  Google Scholar 

  4. (2001) Council NHAMR: Clinical practice guidelines on the use of blood components (red blood cells, platelets, fresh frozen plasma, cryoprecipitate) at http://www.Nhmrc.Gov.Au/publications/synopses/_files/cp78

  5. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507

    Article  PubMed  Google Scholar 

  6. French CJ, Bellomo R, Finfer SR, Lipman J, Chapman M, Boyce NW (2002) Appropriateness of red blood cell transfusion in Australasian intensive care practice. Med J Aust 177:548–551

    PubMed  Google Scholar 

  7. (1996) Practice guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on blood component therapy. Anesthesiology 84:732–747

  8. (2006) Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on perioperative blood transfusion and adjuvant therapies. Anesthesiology 105:198–208

  9. Murphy MF, Wallington TB, Kelsey P, Boulton F, Bruce M, Cohen H, Duguid J, Knowles SM, Poole G, Williamson LM (2001) Guidelines for the clinical use of red cell transfusions. Br J Haematol 113:24–31

    Article  CAS  PubMed  Google Scholar 

  10. Welte M (2009) [Erythrocyte transfusion: update of the guidelines “therapy with blood components and plasma derivatives”]. Anaesthesist 58:1150–1158

    Google Scholar 

  11. Metz J, McGrath KM, Copperchini ML, Haeusler M, Haysom HE, Gibson PR, Millar RJ, Babarczy A, Ferris L, Grigg AP (1995) Appropriateness of transfusions of red cells, platelets and fresh frozen plasma. An audit in a tertiary care teaching hospital. Med J Aust 162: 572–573, 576–577

    Google Scholar 

  12. Schofield WN, Rubin GL, Dean MG (2003) Appropriateness of platelet, fresh frozen plasma and cryoprecipitate transfusion in New South Wales public hospitals. Med J Aust 178:117–121

    PubMed  Google Scholar 

  13. Qureshi H, Lowe D, Dobson P, Grant-Casey J, Parris E, Dalton D, Hickling K, Waller F, Howell C, Murphy MF (2007) National comparative audit of the use of platelet transfusions in the UK. Transfus Clin Biol 14:509–513

    Article  CAS  PubMed  Google Scholar 

  14. Benhamou D (2007) The use of fresh frozen plasma (FFP) in 2007 in France. Transfus Clin Biol 14:557–559

    Article  CAS  PubMed  Google Scholar 

  15. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Epidemiology 18:805–835

    Article  PubMed  Google Scholar 

  16. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) 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 340:409–417

    Article  CAS  PubMed  Google Scholar 

  17. Deans KJ, Minneci PC, Suffredini AF, Danner RL, Hoffman WD, Ciu X, Klein HG, Schechter AN, Banks SM, Eichacker PQ, Natanson C (2007) Randomization in clinical trials of titrated therapies: unintended consequences of using fixed treatment protocols. Crit Care Med 35:1509–1516

    Article  PubMed  Google Scholar 

  18. Nichol AD, Westbrook A, Bellomo R, Cooper DJ (2008) Is it too early to recommend a restrictive transfusion strategy in critically ill patients with ischemic heart disease? Crit Care Med 36:3126–3127

    Article  PubMed  Google Scholar 

  19. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ (2004) The CRIT study: anemia and blood transfusion in the critically ill-current clinical practice in the United States. Crit Care Med 32:39–52

    Article  PubMed  Google Scholar 

  20. Dietrich GV, Schueck R, Menges T, Kiesenbauer NP, Fruehauf AC, Marquardt I (1998) Comparison of four methods for the determination of platelet function in whole blood in cardiac surgery. Thromb Res 89:295–301

    Article  CAS  PubMed  Google Scholar 

  21. Velik-Salchner C, Maier S, Innerhofer P, Kolbitsch C, Streif W, Mittermayr M, Praxmarer M, Fries D (2009) An assessment of cardiopulmonary bypass-induced changes in platelet function using whole blood and classical light transmission aggregometry: the results of a pilot study. Anesth Analg 108:1747–1754

    Article  PubMed  Google Scholar 

  22. Iorio A, Basileo M, Marchesini E, Materazzi M, Marchesi M, Esposito A, Palazzesi GP, Pellegrini L, Pasqua BL, Rocchetti L, Silvani CM (2008) The good use of plasma. A critical analysis of five international guidelines. Blood Transfus 6:18–24

    PubMed  Google Scholar 

  23. O’Shaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S, Williamson LM (2004) Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 126:11–28

    Article  PubMed  Google Scholar 

  24. (2003) [Transfusion with fresh frozen plasma: products, indications]. Ann Fr Anesth Reanim 22:252–261

  25. Expert Working Group (1997) Guidelines for red blood cell and plasma transfusion for adults and children. CMAJ 156 (11 Suppl):S1–S24

    Google Scholar 

  26. Reverberi R (2008) Plasma, guidelines, and evidence-based medicine. Blood Transfus 6:3–5

    PubMed  Google Scholar 

  27. Alport EC, Callum JL, Nahirniak S, Eurich B, Hume HA (2008) Cryoprecipitate use in 25 Canadian hospitals: commonly used outside of the published guidelines. Transfusion 48:2122–2127

    Article  PubMed  Google Scholar 

  28. (2003) Guidelines for the use of platelet transfusions. Br J Haematol 122:10–23

Download references

Acknowledgements

We would like to thank Australian Red Cross Blood Service and the New Zealand Blood Service for excellent collaboration during this study, and the Executive Committee of ANZICS Clinical Trials Group for review and publication endorsement of this study. An unrestricted grant was provided from the Australian Red Cross Blood Service, and the Australian and New Zealand Intensive Care Research Centre.

Author information

Authors and Affiliations

    Consortia

    The Blood Observational Study Investigators on behalf of the ANZICS-Clinical Trials Group

    Additional information

    This article is discussed in the editorial available at: doi:10.1007/s00134-010-1871-z.

    This study is a collaboration of the Australian and New Zealand Intensive Care Society Clinical Trials Group, the Australian Red Cross Blood Service, and the New Zealand Blood Service.

    Appendix

    Appendix

    The Blood Observational Study Writing Committee: A. Westbrook (chair), Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. V. Pettilä (chair), Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. A. Nichol, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Road, Melbourne, VIC, Australia. M. J. Bailey, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. G. Syres, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. L. Murray, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. R. Bellomo, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. E. Wood, Australian Red Cross Blood Service, Melbourne, VIC, Australia; Transfusion Outcomes Research Collaborative, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. L. E. Phillips, Transfusion Outcomes Research Collaborative, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. A. Street, Haematology Unit, The Alfred Hospital, Melbourne, VIC, Australia. C. French, Department of Intensive Care, Western Health, Melbourne, VIC, Australia. N. Orford, Department of Intensive Care, The Geelong Hospital, Geelong, VIC, Australia. J. Santamaria, Intensive Care Unit, St Vincent’s Hospital, Melbourne, VIC, Australia. D. J. Cooper, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Road, Melbourne, VIC, Australia. The Blood Observational Study site investigators are as follows (In alphabetical order—all in Australia unless specified to New Zealand, NZ):

    Alfred Hospital, Melbourne—D. J. Cooper, A. Nichol, A. Street, S. Vallance. Auckland City Hospital, Auckland, NZ—C. McArthur, S. McGuiness, L. Newby, C. Simmonds, R. Parke, H. Buhr. Austin & Repatriation Medical Centre, Melbourne—R. Bellomo, D. Goldsmith, K. O’Sullivan, I. Mercer. Ballarat Health Services, Ballarat—R. Gazzard, C. Tauschke, D. Hill. Bendigo Hospital, Bendigo—J. Fletcher, C. Boschert, G. Koch. Box Hill Hospital, Melbourne—D. Ernest, S. Eliott, B. Howe. Cabrini Private Hospital, Melbourne—F. Hawker. Calvary Mater Newcastle Hospital, Waratah—K. Ellem, K. Duff. Christchurch Hospital, Christchurch, NZ—S. Henderson, J. Mehrtens. Concord Hospital, Concord—D. Milliss, H. Wong. Dandenong Hospital, Dandenong—S. Arora, B O’Bree, K. Shepherd. Epworth Eastern, Melbourne—B. Ihle, S. Ho. Epworth Richmond, Melbourne—B. Ihle, M. Graan. Flinders Hospital, Bedford—A. Bernsten, E. Ryan. Frankston—J. Botha, J. Vuat. The Geelong Hospital, Geelong—N. Orford, A. Kinmonth, M. Fraser. Gold Coast Hospital, Southport—B. Richards, M. Tallott, R. Whitbread. Hawke’s Bay Hospital, Hastings, NZ—R. Freebairn, L. Thomas. Liverpool Hospital. Liverpool—M. Parr, S. Micallef. Lyell McEwin, Elisabeth Vale—K. Deshpande, J. Wood. Middlemore Hospital, Auckland, NZ—T. Williams, J. Tai, A. Boase. Monash Medical Centre, Melbourne- S. Arora, P. Galt. Nelson Hospital, Nelson, NZ—B. King, R. Price, J. Tomlinson. Nepean Hospital, Penrith—L. Cole, I. Seppelt, L. Weisbrodt, R. Gresham, M. Nikas. North Shore Hospital, Auckland, NZ—J. Laing, J. Bell. Palmerston North Hospital, Palmerston, NZ—G. McHugh, D. Hancock, S. Kirkham. Prince of Wales Hospital, Randwick—Y. Shehabi, M. Campbell, V. Stockdale. Queen Elisabeth Hospital, Adelaide—S. Peake, P. Williams. Royal Adelaide Hospital, Adelaide—P. Sharley, S. O’Connor. Royal Darwin Hospital, Darwin—D. Stephens, J. Thomas. Royal Hobart Hospital, Hobart—R. Sistla, R. McAllister, K. Marsden. Royal Melbourne Hospital, Melbourne—C. MacIsaac, D. Barge, T. Caf. Royal North Shore Hospital, Sydney—S. Finfer, L. Tan, S. Bird. Royal Perth Hospital, Perth—S. Webb, J. Chamberlain, G. McEntaggart, A. Gould. Royal Prince Alfred Hospital, Sydney—R. Totaro, D. Rajbhandari. Sir Charles Gairdner Hospital, Nedlands—S. Baker, B. Roberts. St Andrew’s War Memorial Hospital, Brisbane—P. Lavercombe, R. Walker. St George Hospital, Sydney—J. Myburgh, V. Dhiacou. St Vincent’s Hospital, Melbourne—J. Santamaria, R Smith, J. Holmes. St Vincent’s Sydney—P. Nair, C. Burns. Tauranga Hospital, Tauranga, NZ—T. Browne, J. Goodson. Waikato Hospital, Hamilton, NZ—F. van Haren, M. La Pine. Warringal Private, Heidelberg—G. Hart, J. Broadbent. Wellington Hospital, Wellington, NZ—P. Hicks, D. Mackle, L. Andrews. Western Hospital, Melbourne—C. French. H. Raunow, L. Keen. Wollongong Hospital, Wollongong—A. Davey-Quinn, F. Hill, R. Xu.

    Rights and permissions

    Reprints and permissions

    About this article

    Cite this article

    The Blood Observational Study Investigators on behalf of the ANZICS-Clinical Trials Group. Transfusion practice and guidelines in Australian and New Zealand intensive care units. Intensive Care Med 36, 1138–1146 (2010). https://doi.org/10.1007/s00134-010-1867-8

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00134-010-1867-8

    Keywords

    Search

    Navigation