Significant reduction in red blood cell transfusions in a general hospital after successful implementation of a restrictive transfusion policy supported by prospective computerized order auditing

Transfusion ◽  
2014 ◽  
Vol 54 (10pt2) ◽  
pp. 2640-2645 ◽  
Author(s):  
Swaroopa Yerrabothala ◽  
Kevin P. Desrosiers ◽  
Zbigniew M. Szczepiorkowski ◽  
Nancy M. Dunbar
Keyword(s):  
Blood Cell ◽  
General Hospital ◽  
Red Blood Cell ◽  
Successful Implementation ◽  
Restrictive Transfusion ◽  
Red Blood Cell Transfusions

scholarly journals Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial

2019 ◽  
Vol 30 (7) ◽  
pp. 1294-1304 ◽  
Author(s):  
Amit X. Garg ◽  
Neal Badner ◽  
Sean M. Bagshaw ◽  
Meaghan S. Cuerden ◽  
Dean A. Fergusson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Primary Outcome ◽  
Red Blood Cell Transfusion ◽  
Restrictive Transfusion ◽  
Red Blood Cell Transfusions ◽  
Liberal Approach ◽  
Care Costs ◽  
Care Ward

BackgroundSafely reducing red blood cell transfusions can prevent transfusion-related adverse effects, conserve the blood supply, and reduce health care costs. Both anemia and red blood cell transfusion are independently associated with AKI, but observational data are insufficient to determine whether a restrictive approach to transfusion can be used without increasing AKI risk.MethodsIn a prespecified kidney substudy of a randomized noninferiority trial, we compared a restrictive threshold for red blood cell transfusion (transfuse if hemoglobin<7.5 g/dl, intraoperatively and postoperatively) with a liberal threshold (transfuse if hemoglobin<9.5 g/dl in the operating room or intensive care unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied 4531 patients undergoing cardiac surgery with cardiopulmonary bypass who had a moderate-to-high risk of perioperative death. The substudy’s primary outcome was AKI, defined as a postoperative increase in serum creatinine of ≥0.3 mg/dl within 48 hours of surgery, or ≥50% within 7 days of surgery.ResultsPatients in the restrictive-threshold group received significantly fewer transfusions than patients in the liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer transfusions in the restricted-threshold group compared with the liberal-threshold group; P<0.001). AKI occurred in 27.7% of patients in the restrictive-threshold group (624 of 2251) and in 27.9% of patients in the liberal-threshold group (636 of 2280). Similarly, among patients with preoperative CKD, AKI occurred in 33.6% of patients in the restrictive-threshold group (258 of 767) and in 32.5% of patients in the liberal-threshold group (252 of 775).ConclusionsAmong patients undergoing cardiac surgery, a restrictive transfusion approach resulted in fewer red blood cell transfusions without increasing the risk of AKI.

scholarly journals Perioperative Changes in Hemoglobin Levels During Major Hepatopancreatic Surgery in Transfused and Non-Transfused Patients

2020 ◽  
pp. 145749692096436
Author(s):  
J.P. Lammi ◽  
M. Eskelinen ◽  
J. Tuimala ◽  
T. Selander ◽  
J. Saarnio ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Partial Hepatectomy ◽  
Red Blood Cell ◽  
Total Pancreatectomy ◽  
Trigger Points ◽  
Red Blood Cell Transfusion ◽  
Hepatic Surgery ◽  
Restrictive Transfusion ◽  
Red Blood Cell Transfusions

Background: Several studies have shown that restrictive transfusion policies are safe. However, in clinical practice, transfusion policies seem to be inappropriate. In order to assist in decision-making concerning red blood cell transfusions, we determined perioperative hemoglobin (Hb) levels during major pancreatic and hepatic operations. Methods: Patients who underwent major pancreatic or hepatic resections between 2002 and 2011 were classified into the transfused (TF+) and non-transfused (TF) groups. The perioperative Hb values of these patients were evaluated at six points in time. Results: The study included 1596 patients, of which 785 underwent pancreatodu-odenectomy, 79 total pancreatectomy, and 732 partial hepatectomy. Similar perioperative changes in Hb levels were seen in all patients regardless of whether they received a blood transfusion. In patients undergoing pancreatoduodenectomy and total pancreatectomy, the median of the lowest measured hemoglobin values was 89.2 g/L and in partial hepatectomy patients 92.6 g/L, and these were assumed to be the trigger points for red blood cell transfusion. Conclusion: Despite guidelines on blood transfusion thresholds, restrictive blood transfusion policies were not observed during our study period. After major pancreatic and hepatic surgery, Hb levels recovered without transfusions. This should encourage clinicians to obey the restrictive blood transfusion policies after major hepatopancreatic surgery.

Different threshold levels for red blood cell transfusions in patients with haematological malignancy

2009 ◽  
Author(s):  
Rachel Pawson ◽  
Susan Brunskill ◽  
Michael F Murphy ◽  
Carolyn Doree ◽  
Chris Hyde ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Haematological Malignancy ◽  
Threshold Levels ◽  
Red Blood Cell Transfusions
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