higher transfusion triggers at high elevation?

[Mabel Adams]

Does anyone at high elevation use different transfusion guidelines or audit criteria for RBC transfusions than low-landers? We are at 3600 ft. and my medical director feels that using 8 & 24 for H&H provides a better cushion for our elevation than 7 & 21 would.

I suppose we might need to figure out the elevation where the 7 & 21 thresholds were identified. Was it Cleveland Clinic?

Coloradans? You should have a vested interest in this.

[Bill]

Is your hemoglobin "normal" range different than us flatlanders? This difference could give you additional information about hemoglobin requirements.

[Mabel Adams]

Fe 11.7-16.0

Ma 13.5-17.3

These are ours; what are yours in the flatland? It looks like we might not find enough difference so that it is bigger than the variation between instruments.

I see that ARUP in Salt Lake City (pretty high elevation) lists [TABLE=class: MsoNormalTable]

[TR]

[TD=bgcolor: transparent]Age

[/TD]

[TD=bgcolor: transparent]13+ years

[/TD]

[/TR]

[TR]

[TD=bgcolor: transparent]Male (g/dL)

[/TD]

[TD=bgcolor: transparent]14.6-17.8

[/TD]

[/TR]

[TR]

[TD=bgcolor: transparent]Female (g/dL)

[/TD]

[TD=bgcolor: transparent]12.1-15.9

[/TD]

[/TR]

[/TABLE]

[John C. Staley]

Just an FYI. Salt Lake City / ARUP is between 4300 and 4500. When I was about 45 miles north of them and the same elevation we used 8 and 24 as our transfusion triggers.

:juggle:

[Mabel Adams]

Right, John. Now I need some data from flatlanders.

Do you know if you used 8 & 24 because that was the fashion then or because of your elevation?

[Bill]

We are at about 1000 ft and we use 8 & 24 as triggers, our normal ranges are essentially the same as Mabel's.

[Deny Morlino]

770 ft here and the same as Mabel states.

[John C. Staley]

Mable, if I were so bold as to venture a guess I would guess more fashion than science. When I first started and transfusion triggers were kinda new we used 10 and 30. In the mid 80s when transfusing just to make some one feel a little better went out of vogue they started looking around and I think that the 8 and 24 came out as something most physicians could live with (pun intended). I have seen studies in the past that went even lower but they required more thought and individual patient evaluation and not many physicians will admit to having the time to do that.

Logic dictates that lower elevations should be able to utilize lower transfusion triggers but I have never seen any studies that really took elevation into account. They seemed to be much more focused on patient age and factors like that.

[David Saikin]

We discourage the use of triggers and attempt to have our docs treat the pts based on their clinical presnentations . . . but 8 and 24 never fall out.

[DPruden]

There are 3 hospitals in my system in the metro Denver area. We are all somewhere between 5000 and 6000 feet elevation. Our normals for Hgb are Female: 12-16, Male 14-18. We use 8 and 24 for transfusion indications, and we have had specific discussions about keeping them at 8 and 24 because of the altitude.

[Steven Jeff]

I have found this a fascinating discussion as I had never considered the altitude changes with respect to transfusion. Altitude is not really an issue in the UK

Steve

:thanks:

[rrcc1974]

Not many transfusions going on atop Ben Nevis?