We have our inpatient criteria set, but now are working on our outpatient transfusion criteria.  

 

Is anyone willing to share their criteria?

 

Do anyone know of any current reading material about this?  I have found a few but most are over 10 years of age.

 

 

We have the same criteria for all transfusions

We started out with the same criteria, but gave patient's with cancer or myelodysplastic disease currently on chemo one more gram of Hgb (they can give a single unit of PC if below 9 Hgb). Long story short, we could not find any specific criteria for these patients in the literature, but our hem/onc physicians insisted because they are bringing these sick patients in (some from nursing homes, etc) and they just received a dose of chemo. So they were concerned that when their hemoglobin did drop below our criteria, they would have to bring them in twice as often.

They did change from 2 units to 1 unit at a time, so this was a "hill we didn't want to die on". We are already seeing a decrease in transfusions with our new criteria.

For platelets, they have exactly the same criteria as inpatients, and the hem/onc docs were not happy about this either; they now have to be below 10K if not bleeding. But this is a battle we needed to win because we just don't have enough platelets and we really need to hold to this criteria.

We follow the same criteria for inpatients and outpatients, with a little wiggle room for patients who have just received a dose of chemo. Our heme/onc clinic is very much on board with appropriate use of blood products thankfully.

Same criteria

We use the same criteria (Hgb <7.0 gm) but are more lenient with outpatients who are transfusion dependent.  For example, a patient who receives blood on average every theee weeks comes in and the hemoglobin is 7.4 gm.  We know he/she is not going to make it three weeks and will end up coming in emergently needing a transfusion so we allow them to transfuse.  The studies were done on hospital inpatients, who are having labs monitored daily and many are expected to have their Hgb recover without transfusion.  We know the transfusion dependent outpatient or chemo patient is only going to continue to have a fall in Hgb.  Just my two cents.