This is a survey reporting the utilization pattern for 75% of the RBC units delivered by the UK NHSBT to hospitals all over England and North Wales in a 2-week period in 2014.

The main finding is that among RBCs with a known fate two thirds were used for medical indications. While there may have been a drop in surgical blood utilization, this conclusion is not fully supported by the study data. Twenty-five percent of the RBC units are unaccounted for, 7 major hospitals have not participated, and the survey response rates are not given for surgical versus medical departments. The potential impact of the missing data is not fully elucidated. If surgical transfusions for some reason are less prone to be reported, selective surgical underreporting may have been interpreted as a decline in surgical blood use. Furthermore, patients may contribute several times to the survey, which poses a risk that especially some of the haematological indications, counting as medical transfusions, are in fact doublets.

Taking all of this into account, the surgical RBC utilization might be as reported or it might be up till twice as high. Surgical transfusion rates and patient-population-derived RBC utilization could be more precisely calculated by using the number of surgical procedures and the surgical populations as denominators, and the number of transfused patients within these populations as numerators, as recommended by the Joint Commission. However, the study is otherwise comprehensive and other studies support a decline in blood utilization in surgical patients. Medical patients probably represent a relevant future area in PBM.

– Astrid Norgaard

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