An audit of platelet transfusion within the Wellington Cancer Centre

Abstract

Aim: An audit of platelet transfusion was performed to assess adherence to local prophylactic policy and to assess if therapeutic transfusions were administered in line with international recommendations.

Methods: A prospective audit of platelet transfusion therapy was conducted at the Wellington Cancer Centre in patients with hypoproliferative thrombocytopenia over a 3-month period from 26 January 2008 to 30 April 2008. There were 398 episodes of evaluable clinical decision activity generated through either platelet counts <50 × 10(9) /L or platelet transfusion events. Each episode was assessed and defined as either adhering to or breaching the local prophylactic platelet transfusion policy.

Results: Thrombocytopenia and/or platelet transfusion occurred in 63 patients aged 16-84 years with either a haematological or solid organ malignancy. Decisions to withhold prophylactic platelet transfusion in thrombocytopenic patients adhered to policy for 99% of platelet counts <50 × 10(9) /L. Where transfusions were administered, 77% were prophylactic and 23% were for therapeutic indications. Prophylactic transfusions adhered to policy for 72% of platelet counts <50 × 10(9) /L. Adherence to prophylactic transfusion policy for febrile patients with a threshold of ≤15 × 10(9) /L was 84%, compared to 63% for stable afebrile patients with a threshold of ≤10 × 10(9) /L. Where policy was breached, in 80% of cases the platelet count had not reached the prophylactic transfusion threshold. Of the clinical decisions leading to therapeutic transfusions, 67% were deemed appropriate and predominantly a single adult therapeutic dose of platelets was administered. Where multiple doses of platelets were transfused, 86% of these transfusion events either breached policy or were deemed suboptimal management.

Conclusion: The audit demonstrated a high rate of adherence to local transfusion policy. Where policy was breached, predominantly a transfusion had occurred prior to a platelet count reaching the pre-defined trigger. The use of multiple dose platelet transfusions was almost never appropriate. Educating staff in the use of a stringent transfusion policy may lead to reductions in platelet product use.