Appropriateness of red blood cell use in China in the last thirteen years: A systematic review

OBJECTIVE: To determine both the rates of appropriate red blood cells (RBCs) use in China and where inappropriate use is particularly prevalent. BACKGROUND: In China, obtaining the comprehensive picture in unnecessary RBCs transfusion is helpful for understanding the strained blood supplies and targeting training of clinicians. STUDY DESIGN: and methods: Eligible studies were mainly retrieved from four Chinese medical databases and four databases from abroad. In all studies, the appropriateness of RBCs transfusion in transfusion cases, blood request forms, or RBC units within the last thirteen years was determined by using national guidelines. Relationships between RBCs-transfusion appropriateness and type of RBCs-transfusion record, geographical region, level of hospital (LOH-2 and LOH-3), department type (operative vs. non-operative), and study quality (high vs. low) were analyzed by Chi-squared tests. RESULTS: On average, 72.30% (standard deviation, SD = 18.87%) of all cases/forms/units throughout China were appropriate. The appropriateness of RBCs-transfusion differed significantly depending on RBCs-transfusion record type, they were 69.10%, 68.85%, and 75.64% for blood request forms, transfusion cases, and RBCs units, respectively (p < 0.001). The southwest and northeast were the most (80.62%) and the least (66.57%) appropriate transfusion areas, respectively. The coefficients of variances (CV) for the geographical regions differed significantly (0.029–0.39). LOH-3 were more appropriate than LOH-2 (p < 0.001). Non-operative departments were more appropriate than operative departments (p < 0.001). High-quality studies reported higher appropriate rate than low-quality studies (74.48% vs. 69.72%, p < 0.001). CONCLUSION: In China, unnecessary RBCs transfusion was common and may exacerbate the current pressure on blood supplies. Clinicians in certain geographical regions, LOH-2, and operative departments should be targeted with training in transfusion medicine.