Transfusion Process in Outpatient Clinic in a Tertiary Hospital Centre (Proceso de Transfusion en la Clinica de Pacientes Externos en un Terciariocentro Hospitalario)

Introduction: The evidences in transfusional medicine, are realized in patients admitted into the hospital, the criteria for outpatients in the Units of Hospitalization as in the Day Hospital (HDD), may not be the same.It is understood as "Day Hospitalization" patient assistance in the hospital for a few hours, either to perform diagnostic studies, clinical investigations, multiple explorations, or to administer various treatments. One of the treatments that is carried out more extensively in the day hospital regime is the transfusion of blood products. This practice is common not only in Spain, but also in other European countries and in the US, and especially if we refer to transfusion in medical patients, in especially in oncohematology. It is important to note that the US transfuses more blood than other countries for comparable procedures without improved outcomes. There is currently enough evidence to affirm that the transfusion of blood products can be carried out effectively, safely and in accordance with the American Blood Bank Association (AABB) guidelines in the HDD, which entails, among other benefits, a significant reduction in the number of ward days. Transfusion criteria tend to be based on results obtained from clinical trials. Liberal transfusion strategies have not been shown to convey any benefit to patients Transfusion is likely to be indicated in a patient with hemoglobin (Hb) level less than 7 g/dL. AABB recommends a transfusion trigger where Hb is less than 8 g/dL in patients with symptomatic preexisting cardiovascular disease. Transfusion is not likely to be indicated when Hb level is greater than 10 g/d. Material and Methods: Retrospective, open and unicentric study. The period 2012-2013 is compared with 2015-2016. The inclusion criteria cover all patients over 14 years of age, who were transfused in the HURH Day Hospital, regardless of the medical service prescribing the transfusion. Results: From 2012 to 2013, 203 patients were transfused in HDD. Among them, 41.38% were treated in Haematology. The pretransfusional haemoglobin was 7.7 g / dl, with a range of 7.0-8.3 g / dl. 319 transfusion episodes (63.55% of the total) were considered correctly indicated. Haematology service had the highest percentage of transfusions correctly indicated, 230 (72.59%). The difference in adecuated indications between Haematology and the rest of services was 24.4%, which is statistically significant (p <0.001).From 2015 to 2016, 270 patients were transfused in HDD. Of those, 35% belonged to Haematology. The pretransfusional haemoglobin was 7.9 g /dl, with a range of 7.2-8.4 g /dl. A total of 373 transfusion episodes (54.61% of the total) were considered correctly indicated. Haematology service had the highest percentage of transfusions correctly indicated, 233 (61.97%). The difference in indications between Haematology and the rest of services was 16.4%, statistically significant (p <0.001)   Conclusion: The increase in transfusion in our center was 25% from the periods of 2012-13 to 2015-16. This finding is related to the increasing complexity of care and the chronification of several pathologies. The haematology service was the main prescriber, responsible for 15.9% of total transfusions in the HDD. The criteria of transfusion in day hospital in patients with oncological processes have not been sufficiently studied so an extrapolation of other pathologies may not be adequate. It is necessary to consider logistic criteria and the possible benefit in terminal patients Our first results indicate that the HDD is an adequate and cost-effective option to carry out the transfusion activity of a tertiary hospital or care center. Funding Statement: None. Declaration of Interests: The authors have no conflicts of interest to disclose Ethics Approval Statement: This study was approved by Hospital Universitario Rio Hortega, Valladolid, Spain.