Reducing Inappropriate Blood Transfusion in Stable CKD Anemia: Management Stewardship

Quality improvement project

Abstract

Background: Inappropriate transfusions in patients with stable anemia due to chronic kidney disease (CKD) pose serious safety and resource concerns. This study aimed to evaluate and implement a transfusion stewardship program to reduce unnecessary transfusions while maintaining patient safety.

Objective: To evaluate the effectiveness of a structured transfusion stewardship program in reducing inappropriate blood transfusions among patients with stable CKD anemia while maintaining clinical safety.

Methodology: A prospective interventional quality improvement study was conducted in the Department of Nephrology at Ayub Teaching Hospital, Abbottabad, Pakistan, over 12 months. A total of 150 adult patients with CKD stages 3–5 and stable anemia (hemoglobin 8–10 g/dL) were enrolled using stratified random sampling. Baseline transfusion practices were assessed before implementing a stewardship intervention comprising clinician education, audit and feedback, and electronic decision support tools. Data were analyzed using SPSS version 26. 0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Pre- and post- intervention outcomes were compared using paired t- tests and chi- square tests, with p< 0. 05 considered statistically significant.

Results: Among 150 participants, 88 (58.7%) were male, and the mean age was 49.6 ± 12.8 years. At baseline, 120 (80.0%) patients received blood transfusions, of which 50 (33.3%) were considered inappropriate. Following implementation of the stewardship program, inappropriate transfusions decreased significantly to 15 (10.0%) (p < 0.001), while appropriate transfusions increased from 46. 7% to 60. 0%. The average number of transfused units per patient declined from 2. 2.5 ± 0. 0.9 to 2. 1 ± 0. 0.7, without compromising hemoglobin stability (8. 8 ± 0. 0.4 vs. 8. 9 ± 0. 3 g/dL, p = 0. 18).

Conclusion: The transfusion stewardship program was an effective intervention that led to greater transfusion appropriateness, fewer unnecessary transfusions, improved resource utilization, and greater hemoglobin stability. Education, audits, and decision support are key interventions that can improve patient safety in the management of stable CKD anemia.