Dialysis Transfusions and H&H Levels

[jhaig]

We have transfusion criteria for transfusion of RBC's which states that any patient with a Hgb of 8 or less or a Hct of 24% or less get transfused without question. Patients with a Hgb of 8.1-9.9 or a Hct of 24.1%-29.9% can still get blood, but will be reviewed concurrently. Any patient with a Hgb of 10 or more or a Hct of 30% or more that is not either actively bleeding or in the O.R. need pathology approval for RBC transfusion.

We have just opened a new dialysis unit and my question is: do dialysis patients need to follow the same transfusion criteria regarding H&H levels or do they fall into a different category?

[krichards]

We have the same transfusion criteria at our facility. Although I don't recall ever getting a dialysis patient with a Hgb >10, we would simply pass it on to our pathologists for approval. Our pathologists pretty much automatically ok any renal patient, as well as any other conditions which result in chronic anemia.

[John C. Staley]

My experience is that with dialysis patients you will be lucky to see one with a H&H of 8/24. Most of the docs I've worked with will set the H&H they try to maintain for their patients and write it in the orders. Ususally something like: transfuse 2 units if H&H falls below XX. I am not aware of any standards for these patients.

Years ago we had one doc who tried to keep his patients at an active / normal level so he was transfusing 2 - 3 times as much as any other and the units were all washed. When medicare noticed they informed him that keeping the patients alive was enough, they would not pay to keep them active and enjoying a normal life.

[Bill]

Typically, our dialysis patients get 2 units when the Hgb falls below 6.5. However, there are no special criteria for these patients, just what the physician writes in the orders when patient first begins dialysis.