Patient Blood Management Update

Posted on Feb 4, 2019 in Announcements | 0 comments

IMPROVING PATIENT BLOOD MANAGEMENT

Single unit RBC transfusion strategy:  Our continued improvement is impressive – kudos to everyone for embracing this strategy!  69% of transfuse orders are for 1 RBC unit, and a HGB is checked between units ~84% of the time.  The statistics exclude RBC transfusions for sickle cell disease, GI hemorrhage and post-partum hemorrhage.

Recommendation: Don’t transfuse more RBC units than absolutely necessary.  Give single unit RBC transfusions in stable, non-bleeding hospitalized patients; and reassess the patient and check a HGB level after the single-unit transfusion to decide if a second unit is needed.

Department/Group/Provider-specific data has been shared with your leaders.  Please contact Crystal Huber (510-570-6592 or HuberCM@sutterhealth.org) if you are interested in seeing your provider-specific data.

Platelet Transfusions:  For a new diagnosis of thrombocytopenia of unknown etiology, we recommend checking a 1-hour post-transfusion platelet count to help determine the effectiveness of the platelet transfusion and the etiology of the thrombocytopenia.  The 1-hour post-transfusion platelet count must be drawn within 10-60 minutes after the transfusion is competed.  One (1) plateletpheresis unit is expected to increase the platelet count by 30-60K/uL.

  • If the 1-hr platelet count increment shows an appropriate increase, with subsequent drop, then consider consumption/sequestration (such as DIC, splenomegaly).
  • If the 1-hr platelet count increment is less than expected, then consider immune-mediated causes (such as ITP). Consider a Heme-Onc consultation in this situation.

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