Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day»

M Quintana-Diaz; K Nanwani-Nanwani; P Marcos-Neira; A Serrano-Lázaro; R Juarez-Vela; E M Andrés-Esteban

doi:10.1016/j.medin.2020.08.015

Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day»

Med Intensiva (Engl Ed). 2020 Oct 18:S0210-5691(20)30317-X. doi: 10.1016/j.medin.2020.08.015. Online ahead of print.

[Article in English, Spanish]

Authors

M Quintana-Diaz¹, K Nanwani-Nanwani¹, P Marcos-Neira², A Serrano-Lázaro³, R Juarez-Vela⁴, E M Andrés-Esteban⁵

Affiliations

¹ Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España.
² Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España.
³ Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia, Valencia, España.
⁴ Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España; Universidad de la Rioja, Logroño, La Rioja, España. Electronic address: raul.juarez@unirioja.es.
⁵ Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España; Universidad Rey Juan Carlos, Madrid, España.

PMID: 33087293
DOI: 10.1016/j.medin.2020.08.015

Abstract

Objective: To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines).

Design: Prospective, cross-sectional, multi-centre study.

Scope: Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain.

Participants: 1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7±3.8 and average stay of 10.62±17.49 days.

Variables: Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act.

Results: Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8g/dL (95% CI: 6-9-8.5) and 9.8g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p<0.001. The transfusion units had a mean of 2.5±2.4 per patient. The most commonly used blood product was red blood cell concentrate (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p=0.006). 5.4% (7/129) of patients who received red blood cell concentrate died compared to 2.4% (31/1302) who did not (p=0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant.

Conclusions: In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish critical care units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.

Keywords: Anemia; Blood transfusion; Hemoglobin; Hemoglobina; Transfusión sanguínea.