A single unit transfusion policy reduces red cell transfusions in general medical in-patients.

BACKGROUND: The NICE guidelines for blood transfusion and the patient blood management recommendations state that a single unit of red cells should be the standard dose for patients with stable anaemia who are not bleeding. Studies have shown that changing clinical transfusion practice can be difficult and that many clinicians' order two units of blood as standard for patients needing a transfusion. AIM: A collaborative project between NHS Blood and Transplant and Kings College Hospital started in September 2014 to evaluate the impact of a single unit policy on blood usage. DESIGN METHODS: Training and education was undertaken for clinical staff on eight general medical wards and all staff working in the blood transfusion laboratory. We collected transfusion data for 12 months, (6 months before and after implementation). RESULTS: There was a decrease of 50% red cell unit usage between the two periods, equating to a unit cost saving of £28 670. The number of single unit transfusions, increased from 30 to 53% whilst the number of two units decreased from 65 to 43% (P < 0.001). DISCUSSION/CONCLUSION: This project has shown that transfusion practice can be changed and savings in blood usage can be achieved through the successful implementation of the single unit transfusions policy. Key to the implementation was engagement from key medical staff within the medical department in which the policy was implemented and support from the hospital transfusion team. Continued attention and training shall be needed to support these, and implement other, patient blood management recommendations.

A prospective survey of blood products transferred with patients during inter-hospital transfers in the East of England.

OBJECTIVES: A prospective survey was undertaken of blood products transferred with patients during inter-hospital transfers by ambulance in the East of England (population six million) BACKGROUND: There is little published information on the number and fate of blood products transferred with patients during inter-hospital transfers, although there are concerns about quality assurance and traceability of these blood products. Recent national guidance has been issued, but adherence to this guidance is uncertain. METHODS: A 6-month survey was undertaken of all inter-hospital transfers of blood products with patients within the East of England using routine data captured by established transfer of blood documentation. RESULTS: There were 45 transfer episodes of which 44 involved the transfer of red blood cells. In total, 148 units of red blood cells were transferred, of which 6% were transfused en route, 3% transfused at the destination hospital, 35% were wasted and for 18% the fate could not be established. The remainder were transferred into the blood stock of the destination hospital. CONCLUSION: The small proportion of blood products that were transfused raises questions about the necessity of the transfer of blood products with some patients particularly considering the higher percentage of wasted or untraced products. When transfers occur, there should be better communication between hospital transfusion laboratories assisted by adherence to national and regionally agreed policies.

Nutrition, education and fertility behaviour: rural Amritsar.

PIP: This study was undertaken to assess the influence of socioeconomic factors on fertility behavior in the rural Punjab, an area where a broad based rural development strategy has led to rapid socioeconomic change in the past 1 1/2 decades. 350 ever married women and their husbands from rural areas of Amritsar, Punjab, were interviewed in 1977. The number of births was interpreted as a linear function of 9 independent variables: husband's and wife's education, per capita calorie intake, per capita housing use, husband's caste, profession, per capita income, number of years married, and husband's and wife's ages at marriage. Average years of education of husbands was 4 years, while among wives it was 2 years. The average monthly per capita income of Rs. 146 and average per capita calorie intake of 2784 were significantly above the national averages. Average age at marriage was just over 22 for males and just over 19 for females. The average number of births/couple was 5. Husband's education greater than 10 years and wife's education greater than 8 years maximized the fit and were used in the equations. Because of the strong correlation between husband's education and per capita income, 2 alternative regressions were run, 1 with the education and 1 with the income variable. In the 1st regression, the coefficients for husband's education, wife's education, per capita calorie intake, number of married years, and husband's age at marriage were significant at the 1% level, the coefficient for wife's age at marriage was significant at the 5% level, and that for caste was significant at the 10% level. The F value was 58.75 and over 62% of the variation in the number of births was explained by the independent variables. The coefficients in the 2nd equation were also significant except that for per capita income. The coefficient for housing factors, which was not significant in the 1st equation, was significant at the 5% level. Per capita calorie intake was the most important single variable; it was estimated that an 11% increase in the per capita calorie intake would lead to about a 33% decline in births.^ieng