Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland

<div><p>Background</p><p>Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland.</p><p>Methods</p><p>In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed.</p><p>Results</p><p>560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients.</p><p>Conclusion</p><p>This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.</p></div

Transfusion threshold in anemia without acute bleeding and with stable oxygen delivery.

<p>Case vignette #1. In a 72-year-old male patient with stable vital parameters hospitalized due to pneumonia anemia was detected. There were no signs of active bleeding or coronary artery diseases <b>(A, B)</b>. Case vignette #2. Anemia was detected in an 84-year-old female patient with stable vital parameters suffering from osteoporotic fracture of TH12 vertebra. She had known diabetes mellitus type 2, arterial hypertension, and stable coronary artery disease <b>(C, D)</b>. The red bar indicates the recommendation of the AABB guidelines. Regional differences are illustrated on the maps using colored dots which represent teaching hospitals participating in the questionnaire.</p

Knowledge on transfusion related acute lung injury (TRALI).

<p>Physicians knowledge of TRALI and if their knowledge on TRALI influences their transfusion practice.</p

Self-perception of red blood cell (RBC) transfusion practice in anemia.

<p>Self-perception of red blood cell (RBC) transfusion practice in anemia (<b>A</b>). Association between the physician’s self-perception and the place of study (<b>B</b>).</p

Number of physicians responding to the online questionnaire.

<p>560 physicians from 71 Swiss hospitals working in the field of internal medicine participated in this study. The illustration indicates the number of participating physicians of the respective hospital.</p

Definition of anemia.

<p>Threshold of hemoglobin level for men (<b>A</b>) and non-pregnant women (<b>B</b>), below which the presence of an anemia was diagnosed. The red bar indicates the threshold according to the definition of the World Health Organization. Estimated prevalence of anemia in the physician’s own patient population (<b>C</b>).</p

Transfusion threshold in anemic patients suffering from an acute coronary syndrome.

<p>Case vignette #3. A 64-year-old patient with stable vital parameters and without the presence of an active bleeding is hospitalized due to acute coronary syndrome. <b>(A, B)</b>. Regional differences are illustrated on the maps using colored dots which represent teaching hospitals participating in the questionnaire.</p

Availability of guidelines for transfusion of packed red blood cells in the physicians’ work place.

<p>Regional differences are illustrated using coloured dots which represent teaching hospitals participating in the questionnaire.</p