Increase in Hgb after transfusion

[GilTphoto]

The average increase in Hgb after 1 unit of packed cells, is supposed to be 1 gram.

Does anyone monitor when an unusual increase in Hgb after transfusion occurs?

When the pretransfusion Hgb is 7 and 2 units are given and the Hgb jumps to 13, something is wrong. I think it's attributed to specimens drawn from CVP lines from nurses. They are not discarding enough blood, causing the pretransfusion Hgb to be falsely low.

I'm thinking of establishing criteria of >2 grams per unit as the flag for review. Does this sound about right?

Anyone do something similar?

Thanks, Gil

[geekay]

Hi there,

It ultimately depends upon the volume of red cells we transfuse !

and also, fluctuations are common in the values like Haemoglobin% , Blood sugar and Blood pressure, depending upon the technique we use for evaluation. So, considering all these, I think, this "jump by 2%" is acceptable !

Maybe more inputs from the other senior players in this team would be interesting...

best wishes...

[hmust1]

I agree that anything more than a 2g per unit jump is typically a good place to start flagging for further investigation.

However, we recently had a patient respond to a 2 unit infusion with a jump in hgb from 8 to 14 grams. That caused quite a stir...until I investigated and found that the recipient was a 90 lb. 83 yr old lady.

I figured that was probably an acceptable jump given her small size. It's also great documentation to hold up in front of the doc's who wonder why a post infusion H&H is a good idea instead of just reflexing a certain # of units based on H&H alone.

[GilTphoto]

The nursing policy for discarding from CVP lines is 10mL, but every nurse I've spoken to, only discards 5mL. I think this is the problem. We documented 5 cases in March. All had specimens drawn from CVP's. We brought it up with the CNO. Time will see if anything changes!

[GilTphoto]

So, considering all these, I think, this "jump by 2%" is acceptable !..

Not 2%, 2 grams Hgb.

Since the literature says the average increase in Hgb from one unit is 1 gram, I question when the Hgb jumps more than 2 grams.

Does anyone else monitor this for the blood usage review?

[geekay]

HiGilTphoto,

saw your posting today only....sorry for the error which had crept in during my typing.

what I really meant was 2 gm%...

thanks for crrecting me sir..

best wishes...

[LAS]

We have found a bigger bang for our transfusion buck when the pre-transfusion hemoglobin is critically low. In other words, a 2 unit transfusion to a patient with a 5 hgb causes a bigger jump than a 2 unit transfusion to a patient with a 8-9 hgb.

Our chart audits include checking for "response" to transfusion, but the variances in the patients' conditions, diagnosis, etc. would make it difficult to strickly define it. We take it on a case by case basis.

[jhaig]

Stopping I.V. fluids could also lead to an increased Hgb, but I agree that a

2gm increase certainly needs to be looked into. I first check into whether or not the correct patient has been drawn, then I'll look at their chart and look for things like I.V.'s, weight,etc. Case by case is the way to go.

Remember this is only an average increase, and those little old ladies tend to throw off the curve.