Transfusion Criteria

[bevydawn]

Can anyone tell me if there is a recommended H&H standard for the administration of blood? This facility currently reviews everything with a hgb over 8 for non-surgical and over 10 for surgical. However, we now have a new pathologist who is thinking that these are too high. I know most facilities decide what works best for that particular facility but I didnt know if there was any recommended values out there? I've looked but have yet to come up with anything. Thanks for any help.

[Ephraim]

Our hospital set <9g hemoglobin for preoperative and <8g for everyone else. However, they can get around this if there is symptomatic anemia (any degree of blood loss with suspicion of decreased O2 capacity).

[caj1018]

We recently changed our criteria to less than 7 Hgb for all nonbleeding patients. In theory anyway. Currently we do not have a way to see that this actually happens. Currently most of our docs feel that it is ok to transfuse anyone with a HGB less than 10. This is especially true for our nephrologists that feel that 9 is too low for a patient with ESRD. I cannot find any literature to support their claims that these patients should be kept above 9 or 10. Our Pathology dept supports whatever the nephrologist wants to do. How do we educate or physicians?

[Mabel Adams]

There is some evidence that heart attack patients do require higher Hgbs. I can't remember the guideline from the article a few years back, but it was well above 7. Below 7, the risk of cardiac arrest even in normal patients is supposed to increase. You might try the national guideline clearinghouse online. Also, your transfusion committee should be the ones to convince the docs. Sometimes you can have the medical director of your blood center come make a presentation to the medical staff.

[Sandy Jo]

Our general acceptable review criteria is </= 8.0 g/dl hgb and/or </= 25% hct. For patients with CAD, SOB, and/or cardiac ischemia we use hgb </= 10.0 and/or hct </= 30%. For pre-op patients it is hgb </= 9.0 and/or hct </= 27%. Remember, you have to be prepared for the additional work and action needed if you lower the values. You want to maintain a reasonable review for utilization needs, but you have to use care in assessing the local standard of care provided by your physicians. There are publications put out by AABB such as "Guidelines for Blood Utilization Review," that may help you.

[Regina Castor]

I have heard that Puget sound has a really good program that set their threshold at <7g/dL