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Programmed transfusion at predefined frequencies


mpmiola

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In the UK, we have this (relatively new) saying, "Why give two, when one will do?"  This is NOT for someone who is bleeding out, of course, but for your "Average Joe" who needs a transfusion.

It is predetermined what Hb level the patient needs, and a second (or subsequent) unit will not be released unless the patient's Hb has been checked.  If the Hb has reached the predetermined level, the unit will not be released.  This is not something that is decided by the Consultants at the Hospital; this is something that is decided by the Chief Medical Officer (nobody above him/her except the Minister for Health)!

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Just curious Malcolm and Steve but how soon after completion of the transfusion do you check the Hgb/Hct?  Back in the day there was quite a debate going on and I don't remember it ever being resolved.  One study I remember indicated that in order to get an accurate determination you needed to wait 24 hours to let the blood volume equilibrate while another indicated that 1 hour or even less was adequate to determine if additional units were needed.  Also around this same time the general philosophy was if you needed only 1 unit you really didn't need any.  Consequently we rarely if ever gave less than 2.  It was about the time I got out of blood banking that, as Malcolm indicated, why give 2 when 1 will do started to become prevalent.  :coffeecup:

Edited by John C. Staley
I miss spelled Malcolm!! A major phopaw!
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I believe the point of the post-transfusion H&H in this discussion is more to avoid giving another (perhaps) unnecessary unit. 

I think the consensus is that for a Hgb to stabilize fully, you want to look at it at 24 hrs.  However, the H&H done an hour or even a half hour after a transfusion finishes is going to be close enough to make clinical decisions like whether to transfuse another unit.

Scott

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2 hours ago, John C. Staley said:

Also around this same time the general philosophy was if you needed only 1 unit you really didn't need any.  Consequently we rarely if ever gave less than 2.  It was about the time I got out of blood banking that, as Malcolm indicated, why give 2 when 1 will do started to become prevalent.  :coffeecup:

I also remember when the general philosophy was, if you really needed only 1 unit, you really didn't need any, but that was before the time of "evidence-based transfusion".

As a Biomedical Scientist, rather than a Doctor, I always thought that a single unit transfusion (in an adult of course, rather than a baby) was an exercise in the production of alloantibodies, however, the work done by people to show that, not only can people survive on lower levels of haemoglobin than used to be thought, but that people actually thrive at these lower levels of haemoglobin, and spend shorter periods in hospital and get fewer post-operative infections, has convinced me (and thousands of other people) of the value of the single unit transfusion (and, as a side issue, it helps conserve the inventory).

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22 hours ago, Malcolm Needs said:

I also remember when the general philosophy was, if you really needed only 1 unit, you really didn't need any, but that was before the time of "evidence-based transfusion".

As a Biomedical Scientist, rather than a Doctor, I always thought that a single unit transfusion (in an adult of course, rather than a baby) was an exercise in the production of alloantibodies, however, the work done by people to show that, not only can people survive on lower levels of haemoglobin than used to be thought, but that people actually thrive at these lower levels of haemoglobin, and spend shorter periods in hospital and get fewer post-operative infections, has convinced me (and thousands of other people) of the value of the single unit transfusion (and, as a side issue, it helps conserve the inventory).

My sense of the "advantages" of lower hemoglobin levels is not that patients thrive because of lower hgbs, but rather that, in many cases, they can thrive with fewer transfusions.

Scott

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There is a catch-22 there for the clinicians when they think an otherwise stable patient needs a transfusion  If you think the patient needs blood, just one unit should be adequate; and if only one unit is ordered, why transfuse at all?

In general, we require a recent Hgb before routine transfusions.

Scott

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