Jason Edwards, Chris Morrison, Maleeha Mohiuddin, Vladislav Tchatalbachev, Charmi Patel, Vicki L Schwickerath, Jay E Menitove, Gurmukh Singh
Department of Pathology, Truman Medical Center, University of Missouri Kansas City School of Medicine, Kansas City, Missouri 64108, USA.
Transfusion 2012 NovBlood transfusion management strategies minimize transfusion-associated risks, enhance outcomes, and reduce costs. We explored an association of discharge hemoglobin (Hb) with pretransfusion Hb, transfusion indications, and red blood cell (RBC) transfusions. We stipulate that patients with discharge Hb concentrations greater than 10.0 g/dL, or even 9.0 g/dL, received excessive RBC transfusions. We examined aggregate data from five hospitals and for one of the hospitals, the focus hospital, we reviewed patient records for a period of 6 months. Data analyses included number of RBC units transfused and Hb values before transfusion, after transfusion, and at discharge. In aggregate, 27% to 47% patients had discharge Hb levels greater than 10.0 g/dL. At the focus hospital, 27% had a discharge Hb level greater than 10 g/dL and 50.3% had a discharge Hb level greater than 9.0 g/dL. At the focus hospital, the mean Hb trigger for transfusion was a Hb level of 7.3 g/dL; the mean posttransfusion Hb level was 9.3 g/dL and mean discharge Hb level was 9.2 g/dL. Overall, 76% of the transfusions were of an even number of RBC units. In aggregate, overutilization exceeded 20%. At the focus hospital, approximately one-quarter of patients receiving transfusions had a Hb concentration greater than 10.0 g/dL at discharge. Transfused patients' discharge Hb concentration represents an effective indicator for retrospective monitoring of transfusion appropriateness. In light of the large number of patients receiving even number transfusions, reviewing Hb levels after transfusion of each RBC unit could reduce unnecessary transfusions. Retrospective review of discharge Hb data focuses providers on transfusion outcomes and affords an educational opportunity for blood utilization management. © 2012 American Association of Blood Banks.
Jason Edwards, Chris Morrison, Maleeha Mohiuddin, Vladislav Tchatalbachev, Charmi Patel, Vicki L Schwickerath, Jay E Menitove, Gurmukh Singh. Patient blood transfusion management: discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness. Transfusion. 2012 Nov;52(11):2445-51
PMID: 22413968
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