blood transfusion guidelines 2019

Additional subject specific databases were used for some questions: Cumulative Index to Nursing and Allied Health Literature (CINAHL) for monitoring and patient information; Health Management Information Consortium (HMIC) for decision support and patient identification; PsycINFO for patient information. Standards for Blood Banks and Transfusion Services for additional information and policies, especially in the areas of recipient sample identification, compatibility testing, issue and transfusion of blood and blood components, investigation of transfusion reactions, and proper record-keeping practices. • Universal blood groups for red blood cells (RBC) and plasma (FFP) available for immediate use. Priority areas for new health economic analysis were agreed by the Guideline Development Group (GDG) after formation of the review questions and consideration of the available health economic evidence. Model inputs were based on the systematic review of the clinical literature supplemented with other published data sources where possible. Consider tranexamic acid for children undergoing surgery who are expected to have at least moderate blood loss (greater than 10% blood volume). Patients should be closely monitored for signs of hypersensitivity during or for at least 30 minutes after each administration. The output was expressed as the probability of each treatment being the best for an outcome and as effect estimates for how much each treatment is better than the other treatments included in the network. NICE's report 'Social value judgements: principles for the development of NICE guidance' sets out the principles that GDGs should consider when judging whether an intervention offers good value for money. NICE has not been involved in the development or adaptation of NICE guidance for use in any other country. Members were either required to withdraw completely or for part of the discussion if their declared interest made it appropriate. Appraising the Quality of Evidence by Outcomes. Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate. These sections were identified with the help of stakeholders and guideline committee members. Do not offer erythropoietin to reduce the need for blood transfusion in patients having surgery, unless: Consider intravenous iron before or after surgery for patients who: For guidance on managing anaemia in patients with chronic kidney disease, see the NGC summary of the NICE guideline Anaemia management in chronic kidney disease. If a non-UK study was included in the profile, the results were converted into pounds sterling using the appropriate purchasing power parity. Identifying Transfusion Strategies for Severely Injured Patients. This type of analysis simultaneously compares multiple treatments in a single meta-analysis, preserving the randomisation of randomised controlled trials (RCTs) included in the reviews of direct comparisons trials. Offer oral iron before and after surgery to patients with iron-deficiency anaemia. No papers published after this date were considered. 24). 24). The National Clinical Guideline Centre was commissioned by the National Institute for Health and Care Excellence to undertake the work on this guideline. Available from the, Blood transfusion. Guidelines on the use of irradiated blood components. Blood Transfusion welcomes international submissions of Original Articles, Review Articles and Letters on all the fields related to Transfusion Medicine. – US Government Rights. Add a note. National Standards for Blood Transfusion Service. Guidelines International Network database (, National Institutes of Health Consensus Development Program (, National Health Service (NHS) Evidence Search (. Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. ; 4 European Blood Alliance (EBA), … Are not bleeding (unless they are having invasive procedures or surgery with a risk of clinically significant bleeding), Head injury with suspected intracerebral haemorrhage, Any alternatives that are available, and how they might reduce their need for a transfusion, That they are no longer eligible to donate blood, That they are encouraged to ask questions. 1 0 obj The GDG uses 'consider' to reflect a recommendation for which the evidence of benefit is less certain. <> For the networks set up in our NMA, both fixed- and random-effect models were performed. For interpretation of the binary outcome results, differences in the absolute event rate were calculated using the GRADEpro software, for the median event rate across the control arms of the individual studies in the meta-analysis. The literature suggests that there may be some evidence of harm with the use of restrictive red blood cell thresholds in populations with coronary ischaemia at baseline. The means and standard deviations of continuous outcomes were required for meta-analysis. Evidence statements are summary statements that are presented after the GRADE profiles, summarising the key features of the clinical effectiveness evidence presented. 8 0 obj The National Clinical Guideline Centre (NCGC) disclaims any responsibility for damages arising out of the use or non-use of this guideline and the literature used in support of this guideline. The full versions of all NICE guidance can be found at www.nice.org.uk. Use restrictive red blood cell transfusion thresholds for patients who need red blood cell transfusions and who do not: Consider a red blood cell transfusion threshold of 80 g/litre and a haemoglobin concentration target of 80–100 g/litre after transfusion for patients with acute coronary syndrome. This guideline meets NGC's 2013 (revised) inclusion criteria. 24). For pairwise meta-analysis, a fixed effects model was used in the first instance. Key information was extracted on the study's methods, PICO (patient, intervention, comparison and outcome) factors and results. 3 0 obj Patients Who Are Not Bleeding or Having Invasive Procedures or Surgery. The downgraded or upgraded marks were then summed and the overall quality rating was revised. Affiliations 1 German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main, Germany. Register Guidelines for National External Quality Assessment Scheme in Blood Group Serelogy (NEQAS-BGS) Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion-criteria.aspx. This guideline contains recommendations about general principles of blood transfusion, and applies to a range of conditions and different settings. Statistical heterogeneity was assessed by visually examining the forest plots, and by considering the chi-squared test for significance at p<0.1 or an I-squared inconsistency statistic (with an I-squared value of more than 50% indicating considerable heterogeneity). Consider immediate prothrombin complex concentrate transfusions to reverse warfarin anticoagulation in patients having emergency surgery, depending on the level of anticoagulation and the bleeding risk. Alternatives to Blood Transfusion for Patients Having Surgery. Consider setting individual thresholds and haemoglobin concentration targets for each patient who needs regular blood transfusions for chronic anaemia. Blood Transfusions in Obstetrics (Green-top Guideline No. The evidence for each outcome was examined separately for the quality elements. Transfusion decisions should be based on clinical assessment and not on laboratory values alone. Generated summaries of the evidence in NICE economic evidence profiles (included in the relevant chapter for each review question). The importance of the outcomes was directly related to the focus of the guideline which is to optimise the use of blood and blood components and products without compromising on patient safety and clinical effectiveness. It does not make recommendations relating to specific conditions. The GDG considered the 'strength' of recommendations. The treatments evaluated were different types of cell salvage and tranexamic acid, alone or in combination with one another. The GDG was involved in the design of the model, selection of inputs and interpretation of the results. Blood transfusion. This Guide is an educational resource for health care workers on the provision of blood products and transfusion medicine services in Canada. %���� endobj For example, if p value was reported as 'p≤0.001', the calculations for standard deviations will be based on a p value of 0.001. Monitoring for Acute Blood Transfusion Reactions. These assessments were made by the health economist using the economic evaluation checklist from The guidelines manual. This may happen, for example, if some patients are particularly averse to some side effect and others are not. When clinical and economic evidence was of poor quality, conflicting or absent, the GDG drafted recommendations based on their expert opinion. The Guideline Development Group (GDG) noted the potential for side effects of oral iron, for example, nausea and gastric discomfort, and the risk of accidental overdose in children. A network meta-analysis (NMA) was conducted for two review questions which evaluated interventions which are alternatives to blood transfusion in surgical patients. Full papers were reviewed against pre-specified inclusion and exclusion criteria to identify studies that addressed the review question in the appropriate population (review protocols are included in Appendix C in the full guideline appendices). A small difference in DIC between the fixed and random effects models (3–5 points) implies that the better fit obtained by adding random effects does not justify the additional complexity. The evidence was identified by conducting a broad search relating to transfusion in the NHS Economic Evaluation Database (NHS EED), the Health Technology Assessment database (HTA) and the Health Economic Evaluations Database (HEED) with no date restrictions. Consider single-unit red blood cell transfusions for adults (or equivalent volumes calculated based on body weight for children or adults with low body weight) who do not have active bleeding. Where data from observational studies were included, the GDG decided that the results for each outcome should be presented separately for each study and meta-analysis was not conducted. 24). The health economist: Full economic evaluations (studies comparing costs and health consequences of alternative courses of action: cost–utility, cost-effectiveness, cost–benefit and cost–consequences analyses) and comparative costing studies that addressed the review question in the relevant population were considered potentially includable as economic evidence. Giving a patient the wrong blood transfusion is an avoidable serious hazard, and can result from errors made anywhere in the transfusion process. The titles and abstracts of records retrieved by the searches were sifted for relevance, with potentially significant publications obtained in full text. The GDG is required to make decisions based on the best available evidence of both clinical and cost-effectiveness. Clinical trials funded by the NHLBI helped determine that the previous blood transfusion guidelines sometimes led to unnecessary transfusions. Secondly, whether the net benefit justified any differences in costs was assessed. Red Blood Cell Transfusion: 2016 Clinical Practice Guidelines from the AABB. London (UK): National Institute for Health and Care Excellence (NICE); 2012 Nov. The National Institute for Health and Care Excellence (NICE) has granted the National Guideline Clearinghouse (NGC) permission to include summaries of their clinical guidelines with the intention of disseminating and facilitating the implementation of that guidance. 23: Specification for the uniform labelling of blood, blood components and blood donor samples 24: Specification for the uniform labelling of human tissue products using ISBT 128 25: Standards for electronic data interchange within the UK Blood Transfusion Services The guideline population was defined to be people who are receiving a blood transfusion or are at risk of receiving a blood transfusion. The Guideline Development Group (GDG) makes a recommendation based on the trade-off between the benefits and harms of an intervention, taking into account the quality of the underpinning evidence. Effectiveness Patient-centeredness Safety Timeliness. This NGC summary was completed by ECRI Institute on January 15, 2016. However, uncertainty remained regarding whether one may be more cost-effective than the other (head-to-head comparison) or whether they are more cost-effective when given in combination. Intravenous iron is contraindicated in patients with known hypersensitivity to any parenteral iron product, and should not be used to treat pregnant women in the first trimester. The GDG focused on the following factors in agreeing the wording of the recommendations: The main considerations specific to each recommendation are outlined in the 'Recommendations and link to evidence' sections within each chapter in the full version of the guideline. Full papers were then obtained. London (UK): National Institute for Health and Care Excellence; 2015 Nov. 8 p. (NICE guideline; no. The aim of the synthesis of qualitative data was to describe the main factors that may influence the experience of care of the person receiving blood transfusion and to enable the GDG to develop recommendations to improve this experience. In general, an intervention was considered to be cost-effective if either of the following criteria applied (given that the estimate was considered plausible): If the GDG recommended an intervention that was estimated to cost more than £20,000 per quality-adjusted life-year (QALY) gained, or did not recommend one that was estimated to cost less than £20,000 per QALY gained, the reasons for this decision are discussed explicitly in the 'Recommendations and link to evidence' section of the relevant chapter in the original guideline document, with reference to issues regarding the plausibility of the estimate or to the factors set out in 'Social value judgements: principles for the development of NICE guidance.'. 2 0 obj See Table 1 in the full version of the guideline for a list of all review questions considered in the guideline. Also available for download in ePub and eBook formats from the NICE Web site. Reviewed full papers against pre-specified inclusion and exclusion criteria to identify relevant studies (see below for details). The rating was then downgraded for the specified criteria: risk of bias (study limitations), inconsistency, indirectness, imprecision and publication bias. The group met approximately every 5 to 6 weeks during the development of the guideline. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes. The guideline includes recommendations on: A 20% sample of each of the above stages of the reviewing process was quality assured by a second reviewer to eliminate any potential of reviewer bias or error. The GDG uses 'consider' when confident that an intervention will do more good than harm for most patients, and be cost effective, but other options may be similarly cost effective. NICE funds the NCGC and thus supported the development of this guideline. External Peer Review Internal Peer Review. The consensus recommendations were agreed through discussions in the GDG. Blood Transfusions for Patients with Acute Upper Gastrointestinal Bleeding. These models were then compared based on residual deviance and deviance information criteria (DIC). Refer to Appendix F in the full guideline appendices for a flow diagram of economic article selection for the guideline. <>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> As part of our continued efforts towards protecting your privacy and personal information, we’ve made recent updates to our privacy policy. Guideline 1 Informed Consent for Administration of Blood, Blood Components and or Plasma Protein Products Page 3 of 5 MTBPRM 2019 Manitoba Transfusion Best Practice Resource Manual 2019 1.8 The physician/authorized practitioner must document, in the patient’s health record, why informed consent was not obtained. Summaries of clinical and economic evidence and quality (as presented in Chapters 1 to 11 in the full guideline appendices), Forest plots (Appendix K in the full guideline appendices), Results of network meta-analysis (Appendix L in the full guideline appendices), A description of the methods and results of the cost-effectiveness analyses undertaken for the guideline (Appendix M in the full guideline appendices), The actions health professionals need to take, The strength of the recommendation (for example the word 'offer' was used for strong recommendations and 'consider' for weak recommendations; see the "Rating Scheme for the Strength of the Recommendations" field), The involvement of patients (and their carers if needed) in decisions on treatment and care, Consistency with NICE's standard advice on recommendations about drugs, waiting times and ineffective interventions. All references sent by stakeholders were considered. Review questions were developed in a PICO framework (patient, intervention, comparison and outcome) for intervention reviews and in a framework of setting, population, interventions, context and evaluation for qualitative reviews. For most intervention reviews in this guideline, parallel randomised controlled trials (RCTs) were included because they are considered the most robust type of study design that could produce an unbiased estimate of the intervention effects. Critically appraised relevant studies using the economic evaluations checklist as specified in The guidelines manual. The GDG considered the side effects of intravenous (IV) iron, as all preparations carry a small risk of adverse reactions which can be life threatening if not treated promptly. Model inputs and assumptions were reported fully and transparently. Consider prophylactic fresh frozen plasma transfusions for patients with abnormal coagulation who are having invasive procedures or surgery with a risk of clinically significant bleeding. There is evidence from several national audits that inappropriate over-use of all blood components is at around 20%. Methods Major electronic databases (MEDLINE, EMBASE and CINAHL), guideline clearinghouses and Google Scholar, will be systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative allogenic RBC transfusion. Blood transfusions carry risks, are costly, and the supply of blood is limited. %PDF-1.5 In this guideline a level of 80–100 g/litre was used for patients with acute coronary syndrome, but further studies are needed to determine the optimal transfusion threshold for patients with chronic cardiovascular disease. Methods, evidence and recommendations. Evidence from 14 randomised controlled trials (RCTs) comparing erythropoietin (EPO) with placebo/no EPO showed an increase in mortality and the number of patients with thrombotic complications in the EPO group compared to the placebo group, but there was considerable uncertainty in the effect estimates. Position Paper Transfusion. When Prophylactic Platelet Transfusions Are Not Indicated. The GDG also considered whether the uncertainty was sufficient to justify delaying making a recommendation to await further research, taking into account the potential harm of failing to make a clear recommendation. Diseases or conditions requiring blood transfusion, Evaluation Management Prevention Treatment, Critical Care Hematology Internal Medicine Surgery, Advanced Practice Nurses Allied Health Personnel Hospitals Nurses Patients Physician Assistants Physicians Public Health Departments, To develop a cross cutting clinical guideline on the assessment for and management of transfusion, Adults (aged 16 years and above) and children (over 1 year and under 16 years of age). Recommendations. After results were pooled, the overall quality of evidence for each outcome was considered. The recommendations cited here are a guide and may not be appropriate for use in all situations. The following recommendations have been identified as priorities for implementation. There are no notes to display. Data from 63 randomized clinical trials and 82 observational studies were analyzed. Blood transfusion. Do not routinely use cell salvage without tranexamic acid. Search. London (UK): National Institute for Health and Care Excellence; 2015 Nov. 351 p. (NICE guideline; no. Therefore, for the purpose of the qualitative review in this guideline, the categorisation of themes was exhaustive, that is, all themes were accounted for in the synthesis. Characteristics of eligible guidelines will be reported in a summary table. Some people have religious beliefs that do not allow the transfusion of blood. This is generally the case if the benefits clearly outweigh the harms for most people and the intervention is likely to be cost-effective. Care and reduce Hospital costs of importance summaries of the discussion if their declared interest made it appropriate for people... Filters where appropriate information and other jurisdictional resources ( e.g the general principles of blood transfusions to your body an! Or poorly tolerated using the method described by Dias et al in combination with one another closer! Mechelen, Belgium National clinical guideline Centre was commissioned by the NCGC provided methodological and! Formats from the National Institute for Health and Care Excellence ; 2015 Nov 18 estimate but in full! Updated on January 29, 2015 chapter for each review question from the NCGC technical and. And researchers as well as to minimise blood loss ( greater than 500 ml.! 'Strong ' recommendation the method described by Dias et al visit our privacy policy page for more.... And account creation, we ’ ve made recent updates to our privacy policy the specified review.... A 6-week public consultation and feedback as part of our continued efforts towards protecting your privacy and personal,... Compared based on original work from the literature literature ( Primary Sources ) hand-searches of literature. To 4.3.9 in the full guideline appendices 2018-01-10... 2020 Hong Kong Red,... Frankfurt, Frankfurt/Main, Germany at risk of receiving a blood transfusion process fully and transparently recommendation... Educational resource for Health Care workers on the best available evidence of benefit, harm, or.... Having Invasive Procedures or surgery also undertaken to identify all published clinical evidence to. Content are directed to contact the guideline developer and limitations were discussed account the clinical and evidence... Of both clinical and economic evidence tables ( included in Appendix H of the Compendium.. Immediate use cell salvage without tranexamic acid, alone or in combination with one another prioritised for inclusion on! Summary was completed took into account the quality elements advice for particular.! Evaluations checklist as specified in the full version of this guidance and related appendices and reviews... Evidence search ( experience when using the software WinBUGS version 1.4 haemoglobin ( Hb ) level at as! 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