Authors (including presenting author) :
Zheng KYC (1), Wu PY(1), Chan K(1)
Affiliation :
(1)Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital
Introduction :
Cytopenia, particularly anaemia, is prevalent among cancer patients due to various disease-related effects and treatment-related marrow suppression. The Hospital Authority (HA) has instituted guidance for the clinical administration of blood products, and the Department of Clinical Oncology at Pamela Youde Nethersole Eastern Hospital (PYNEH) has developed local guidelines on Patient Blood Management (PBM) and Iron Replacement in 2021, aiming to establish a structured and evidence-based approach to optimise PBM in cancer patients.
Objectives :
This audit evaluates transfusion practices within the Department of Clinical Oncology, PYNEH, including adherence to existing HA and departmental guidelines, patterns of care in PBM, and identify potential areas to improve the quality of care.
Methodology :
The audit consisted of Phase I (January-June 2023), and Phase II (August-December 2024) after implementation of relevant improvement interventions. Clinical data on transfusion involving red cells, platelets, and plasma were analysed. Performance indicators encompassed appropriateness of transfusion triggers (stipulated in the HA Transfusion Guidelines), single-unit red cell transfusions where appropriate, and timely provision of haemostatic interventions for clinical bleeding. In addition, patterns of care in the identification and management of iron deficiency in cancer patients were assessed.
Result & Outcome :
Phase I identified a total of 263 transfusion episodes among 104 patients. Appropriate triggers for red cell transfusion were met in 96.5% of cases, with single-unit transfusion rate of 96.5% (where appropriate). 96% of patients with clinical bleeding were offered timely haemostatic interventions. All platelet and plasma transfusion episodes followed appropriate indications. Although investigation of the underlying cause of anaemia followed individual clinical discretion, a relatively low rate of iron profile checking (44.3% of cases) was observed. In response to the Phase I findings, education to the clinical team to reinforce evidence-based PBM practices were organised, followed by revision of departmental guidelines. In Phase II, 153 transfusion episodes were identified among 71 patients. Substantial improvement in transfusion practices were observed. Adherence to appropriate transfusion triggers for blood products and single-unit red cells transfusion (where applicable) reached 100%. Additionally, haemostatic interventions for patients with clinical bleeding improved to 100%. Observation of iron profile checking increased significantly to 75.4%, and iron replacement were prescribed where indicated. Clinical audit and appropriate departmental initiatives were shown to be effective in improving the quality of PBM in cancer patients.
