Transfusion Criteria

[cmiller]

We are looking to revise our transfusion indicators.

We would like to lower the Hgb criteria for RBC transfusions.

Would anyone be willing to share their criteria used for blood usage reviews?

If so, please email me at cmmcoy@apprhs.org

Thank you.

[PamD]

If you go to cbbsweb.org they have a link to download the ARC practice guideline. Lots of good criteria for transfusing products. The link is on the lower right corner of the home page.

[ybunch]

We are in the same process. www.sabm.org has some sample sets.

[bloodpumper]

Blood usage reviews and criteria for transfusion are two different things. I will address the transfusion of red cells criteria. There just isn't any Level I, Class A evidence to say one way or another what a transfusion trigger should be for red cells as no prospective randomized clinical trials have been conducted, for ethical reasons, to determine the benefit of transfusion. Animal studies and clinical experience with JW patients tells us that the critical level of hematocrit can be as low as 15% in healthy patients and as high as 30% for individuals with major complications of surgery or ischemia. Recent evidence has pointed to patients having a better outcome with a hematocrit greater than 21% but not greater than 27% and receiving a transfusion. Almost all studies state that a transfusion is associated with increased morbidity and mortality and is dose dependent in relation to severity of complications. We are moving toward using clinical indicators of tissue oxygenation with O2 difference and cardiac output instead of just treating a number to transfuse. Clinical evidence of tissue oxygen debt is far more justifiable than just giving blood because of a designated number with no proven evidence in its favor. Another thing to consider is that stored red cells acquire storage defects and they don't release oxygen readily. This may exacerbate tissue ischemia by decreased NO2 and red cell wall deformability. I know I haven't answered your question and may have given you more to ask, but the reality is that a transfusion trigger is far less accurate than a measured need for increased tissue oxygenation. The need for transfusion should be patient specific and not blanket therapy.