Evaluation of the appropriateness of blood and blood product transfusion using preset criteria.

The use of 1930 units of blood or blood products during 765 transfusion episodes in 560 patients was reviewed. This represented one-half of all transfusions in a large medical center over a 2-month period. By clearly defined, present criteria, 42.3 percent of the episodes were found not to be appropriate. Whole blood and platelet transfusions were used more appropriately than those of red cells, cryoprecipitate, and fresh-frozen plasma. Blood transfusions were used more appropriately in the management of acute bleeding or anemia associated with cardiovascular problems. Three groups of patients were especially prone to inappropriate transfusions: those with end-stage renal disease or terminal cancer and cancer patients on chemotherapy. Age, sex, and specific hospital wards were not associated with inappropriate use. Most unjustified episodes occurred as a result of the overestimation of the immediate risk incurred by withholding transfusion.