Patient blood transfusion management

Discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness

Jason Edwards, Chris Morrison, Maleeha Mohiuddin, Vladislav Tchatalbachev, Charmi Patel, Vicki L. Schwickerath, Jay E. Menitove, Gurmukh Singh

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Blood 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. Study design and methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)2445-2451
Number of pages7
JournalTransfusion
Volume52
Issue number11
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

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Blood Transfusion
Hemoglobins
Erythrocytes
Biomarkers
Erythrocyte Transfusion
Patient Discharge

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Patient blood transfusion management : Discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness. / Edwards, Jason; Morrison, Chris; Mohiuddin, Maleeha; Tchatalbachev, Vladislav; Patel, Charmi; Schwickerath, Vicki L.; Menitove, Jay E.; Singh, Gurmukh.

In: Transfusion, Vol. 52, No. 11, 01.11.2012, p. 2445-2451.

Research output: Contribution to journalArticle

Edwards, J, Morrison, C, Mohiuddin, M, Tchatalbachev, V, Patel, C, Schwickerath, VL, Menitove, JE & Singh, G 2012, 'Patient blood transfusion management: Discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness', Transfusion, vol. 52, no. 11, pp. 2445-2451. https://doi.org/10.1111/j.1537-2995.2012.03591.x
Edwards, Jason ; Morrison, Chris ; Mohiuddin, Maleeha ; Tchatalbachev, Vladislav ; Patel, Charmi ; Schwickerath, Vicki L. ; Menitove, Jay E. ; Singh, Gurmukh. / Patient blood transfusion management : Discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness. In: Transfusion. 2012 ; Vol. 52, No. 11. pp. 2445-2451.
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AB - Background: Blood 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. Study design and methods: 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. Results: 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. Conclusion: 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.

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