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PRBC Transfusions Medicine Floors Michael Cho, MD Internal Medicine, PGY-3 July 19, 2013. “If the hemoglobin is less than 8, t ransfuse 2 units PRBC.”. Transfusion Thresholds. Blood Transfus . 2012.0195-12: 1-11. CAP: College of American Pathologists.
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PRBC Transfusions Medicine Floors Michael Cho, MD Internal Medicine, PGY-3 July 19, 2013
“If the hemoglobin is less than 8, transfuse 2 units PRBC.”
Transfusion Thresholds Blood Transfus. 2012.0195-12: 1-11. CAP: College of American Pathologists. ASA: American Society of Anesthesiologists. STS: Society of Thoracic Surgeons. SCCM: Society of Critical Care Medicine. SIMTI: Italian Society of Transfusion Medicine and Immunohaematology. AABB: American Association of Blood Banks.
American Red Cross Guidelines TRANSFUSE FOR: • SYMPTOMATIC anemia • CLINICALASSESSMENT, not just a lab value • SINGLE UNIT, except acute hemorrhage
PRBC Transfusions Internal Medicine Study Period: 12/2012 Where: Tower Hospital Patients: 37 patients with 52 transfusion orders PRBC transfused: 101 units Time to 1st Transfusion:4.1 days Transfusion Orders by Diagnosis
Conversion 1 unit of PRBC increases Hemoglobin by 1
Inpatient PRBC Transfusions – All Services ONE YEAR - May 2012 to April 2013 • Total patients: 2,288 • Total cases: 2,748 • Total pRBC units transfused: 10,770 • Units transfused per order: 2.1 • Units transfused per case: 3.9 • Cost for each unit pRBC with labs: $356 • Total direct cost (labs & blood): $3,800,000
Patient Blood Management PBM is a patient-centered, evidence-based approach to preventing avoidable transfusions and ensuring the safe and efficient use of blood components when necessary. • Early diagnosis and treatment of anemia using pharmaceutical interventions rather than transfusion • Strict transfusion triggers • Minimizing blood loss during hospitalization • Healthcare worker education In 2007, Eastern Maine Medical Center, a 411 bed facility, began a Patient Blood Management program.
Potential Savings from Patient Blood Management • PRBC transfused annually: 10,770 units • Total annual direct cost: $3,830,000 • PRBC transfused after PBM with potential 60% reduction: 4,300 units • Revised total annual direct cost: $1,530,000 • Potential annual savings: $2,300,000
INDIRECT COSTS • Allergic reaction and hives • Fever • Transfusion-associated circulatory overload (TACO) • Transfusion-related acute lung injury (TRALI) • Bloodborne infections • Acute immune hemolytic reaction • Delayed hemolytic reaction • Iron overload • Graft-versus-host disease
Patient Outcomes Restrictive transfusions lead to either no change or improved patient outcomes when compared to liberal transfusion strategies. STUDIES • ICU patients. TRICC. NEJM 340 (6): 409-417. • Anemic post-operative hip surgery patients. FOCUS. NEJM 365 (26): 2453-2462. • Acute Upper GI Bleed. NEJM 368 (1): 11-21.
Special Thanks: Lloyd Rucker, MD Minh-Ha Tran, MD BinduSwaroop, MD Maggie Macari-Hinson, RN, MSN, CCM Eric Belen, MBA