1 / 17

PRBC Transfusions Medicine Floors Michael Cho, MD Internal Medicine, PGY-3 July 19, 2013

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.

destiny-compton
Download Presentation

PRBC Transfusions Medicine Floors Michael Cho, MD Internal Medicine, PGY-3 July 19, 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PRBC Transfusions Medicine Floors Michael Cho, MD Internal Medicine, PGY-3 July 19, 2013

  2. “If the hemoglobin is less than 8, transfuse 2 units PRBC.”

  3. 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.

  4. American Red Cross Guidelines TRANSFUSE FOR: • SYMPTOMATIC anemia • CLINICALASSESSMENT, not just a lab value • SINGLE UNIT, except acute hemorrhage

  5. 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

  6. Conversion 1 unit of PRBC increases Hemoglobin by 1

  7. Internal Medicine PRBC Transfusions +2+2

  8. 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

  9. 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.

  10. Patient Blood Management Results

  11. 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

  12. 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

  13. 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.

  14. Special Thanks: Lloyd Rucker, MD Minh-Ha Tran, MD BinduSwaroop, MD Maggie Macari-Hinson, RN, MSN, CCM Eric Belen, MBA

More Related