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1. Short name Use of blood components

2. Detailed name Blood components transfused per patient.

3. Shortdenition

Number of blood components transfused perpatient during selected tracer procedures in thehospital.

4. Rationale(including

ustication!strengths andlimits"

Rationale#

- Blood transfusions are common in surgicalpatients ($". %o&e'er! attitudes to&ard bloodtransfusion ha'e changed in the last decade.lthough transfusion can be lifesa'ing! recente'idence suggests that their use is associated

&ith increased morbidit) and mortalit) andtherefore! current transfusion practices ma)re*uire re+e'aluation (2!3".

- Despite e'idence supporting more restricti'e useof blood! the use of transfusions among surgicalpatients has increased during the last decade (4".

- ,atients are concerned about the safet) of bloodtransfusion and pa)ers about the costs of bloodtransfusion. -here is still insucient informationon the clinical use of blood in electi'e surger)and there are large recorded 'ariations in

transfusion practices. Studies ha'e demonstratedhigh 'ariabilit) in red blood cell (RB/"transfusions and blood loss in standard surgicalprocedures (0+1".

- Demand for blood products is gro&ing and itoften eceeds the resources of the local bloodban! thereb) disrupting both the planning andthe nature of surgical protocols. -herefore! it isnecessar) to streamline blood ordering andtransfusion practice.

- number of studies sho&ed o'er+ordering of

blood components b) surgeons or b)anesthesiologists.

/ontents#

Short name

Detailed name

Short denition

Rationale

perational denition

,re'ious ,-% eperience

Data source

Domain

-)pe of indicator

dustment5 stratication

Sub+indicators

Related indicators

6nterpretation

7uidelines

References

Use of blood components

December 2889

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PAGE 2 USE OF BLOOD COPO!E!"S

$. - 'er+ordering of blood has to be minimised# Demanding large *uantiof blood each da)! of &hich little is ultimatel) used commits 'alusupplies and resources both in technician time and reagents.

- -he read) a'ailabilit) of blood components often results in liberal usblood. 6n adults! blood loss of up to 28: (about one liter for an a'erperson &ith 18 g of bod) &eight" is &ell tolerated in the maoritpatients! pro'ided that the circulator) 'olume is compensatedcolloids or cr)stalloids". -ransfusion of red cell concentratesrecommended onl) if there is ;38: blood loss (

- n epert consensus conference con'ened b) United States ?oodDrug dministration concluded that transfusion &as liel) tonecessar) &hen the %b 'alue dropped belo& 1 g5dl and unliel) tnecessar) &hen it &as greater than $8 g5dl ($$".

Strengths-here is a strong association of RB/ transfusion &ith mortalit)postoperati'e morbidit). RB/ transfusion increases ris for mortalit)se'eral morbidities in surgical patients (3!$2!$3". Benchmaring transfuacti'it) ma) help to decrease the inappropriate use of blood products! redthe cost of care and optimi=e the use of 'oluntar) donor@s gift.

Limitations-here might be substantial di>erences in the blood components practicesacross hospitals and across countries! &hich ma) reduce the comparabilit)the results. ?urthermore! blood transfusion ma) be a>ected b) the local supof blood products! in a &a) that a serious shortage ma) cause under+representation of the blood components use! especiall) in countries that aroften facing blood donor shortage periods.

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PAGE #USE OF BLOOD COPO!E!"S

2. perationaldenition

!$merator

-he amount of intra+ and postoperati'e blood components transfused forpatients in'ol'ed in denominator.

Denition of component for transfusion# component for transfusioprepared either from &hole blood donation (408A5+ $8:" m or collectedaphaeresis. ne unit means component deri'ed from &hole blood dona(408A5+ $8:" m. ?or platelet aphaeresis! the number of units collected fthe donor in one session should be sho&n on the label or contained inproduct information leaCet (7uide to the preparation! use and *uassurance of blood components! Recommendation No. R (90" $0! /ounciurope! 288

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PAGE % USE OF BLOOD COPO!E!"S

3. Denom&nator

ll patients &ho under&ent selected electi'e surgical procedures in a gitime period (based on the DR7 code! see belo&" for &hich intra+operaand5or postoperati'e transfusion &as re*uested.

E'cl$s&on

($" ,atients no&n to ha'e pre+eisting abnormalities of the coagulas)stem (documented b) histor) of bleeding and5or preoperati'e internatinormalised ratio ;$.0 or prothrombin time (,-" EF8.30G thromboc)te c

E08 8885Hl".(2" ,atients submitted to more than one t)pe of surgical procedure duringsame hospital episode.

(3" Re+operated patients for the same t)pe of procedure.

Tracer procedures (ustralian DR7 codes"# lecti'e surgical procedselected because the) are fre*uentl) performed and often in'ol'e or min'ol'e blood transfusion#

Aortofemoral b(passI unilateral (?" DR7 3218

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PAGE ,USE OF BLOOD COPO!E!"S

L. Domain /linical e>ecti'eness

Safet)

Responsi'e go'ernance

1. -)pe ofindicator

utcome measure

,

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cross+match.

$8.Relatedindicators

+ ength of hospital sta)!-he follo&ing indicator are not computed in the frame of ,-%@89 but ifmonitored in the hospital! it might be rele'ant to relate to#+ ,atient epectations+-raining ependiture

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$$.6nterpretation

6mpro'ement in'ol'es better coordination of care (surger)! blood banhospital transfusion ser'ice! anesthesiolog) and nursing" andappropriate use of blood.

Studies report &ide 'ariations in blood utili=ation bet&een and &icountries! e'en &ithin the same hospital. Mariations mainl) reCect lpractices despite the number of published guidelines concerning the optiuse of blood and blood components in di>erent clinical settings. 6n turn!means that the interpretation must be performed cautiousl)! taingaccount all possible modif)ing e>ects.

ther factors to tae into account are# -he use of technologies to decreperioperati'e allogenic blood transfusion! including pharmaceutical drugs sas aprotinin! desmopresin! traneamic acid! er)thropoietin and autologtransfusion techni*ues such as N% (autologous normo'olehaemodilution"! 6/S (6ntraoperati'e /ell Sar'er"! ,D (,reoperati'e autologdonation" and ,S (,ostoperati'e sal'age" ($4!$0". -he administratioantibrinol)tic (traneamic acid" in total hip replacement is e>ecti'reducing the blood loss and transfusion re*uirements! especiall) in &oand also e>ecti'e in total nee replacement surger) ($L!$1".

$2.7uidelines 7uidelines on the Kanagement of Kassi'e Blood oss. )ritish *ournal of+aematolog,288LG $30(0"# L34+4$.

7uidelines for the use of fresh+fro=en plasma! cr)oprecipitate andcr)osupernatant. Brit %aematol 2884!$2L!$$+2

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$3.References . Mam'aas /. pidemiolog) of red blood cell utili=ation. -ransfus Ked$99LG$8($"#44+L$.

2. Kari ,! /or&in %. cac) of red blood cell transfusion in the criticall) is)stematic re'ie& of the literature. /rit /are Ked 288

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$9