title: Monitoring for undertransfusion.
abstract: BACKGROUND
  Most published reviews and audits of blood and blood component transfusion have focused on the issue of overtransfusion and on the inappropriate use of red cell components. There is growing concern that efforts to curb unnecessary transfusions may result in a trend toward undertransfusion of patients. There is little published information that addresses this issue or the magnitude of this practice.
  
  
  METHODS
  Undertransfusion was evaluated by examining the transfusion records from a 3-month period for 55 patients who met the study criteria of having either a hemoglobin level < 7 g per dL or a platelet count of < 10 x 10(9) per L. If the identified patient did not receive a transfusion within 24 hours of the reported hemoglobin level or platelet count, the medical record was reviewed by a resident physician.
  
  
  RESULTS
  A total of 213 individual hemoglobin levels and platelet counts, representing the 55 patients, met our transfusion criteria. All except 8 of the identified patients received red cells and/or platelet transfusions. Reasons for not transfusing red cells included the patient's response to nutritional support and iron supplementation, refusal of blood, and noncompliance. Reasons for not transfusing platelets included falsely low platelet count because of platelet clumping in vitro, contraindication based on clinical diagnosis (e.g., immune thrombocytopenic purpura), and the patient's death before transfusion.
  
  
  CONCLUSIONS
  Red cell and platelet transfusions were appropriately ordered for all patients who met the transfusion criteria. Undertransfusion is not a problem at this institution according to the criteria established. It is recommended that other institutions expand their blood utilization audits to include investigation for evidence of undertransfusion. Further research regarding the issue of undertransfusion is warranted and could be expanded to include other components.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of South Florida College of Medicine, Tampa, USA.
authors.forename: B
authors.initials: B
authors.lastname: Mair
authors.forename: S J
authors.initials: SJ
authors.lastname: Agosti
authors.forename: P R
authors.initials: PR
authors.lastname: Foulis
authors.forename: R A
authors.initials: RA
authors.lastname: Hamilton
authors.forename: K
authors.initials: K
authors.lastname: Benson
mesh_terms: D000437:Alcoholism / Q000150:complications; D000740:Anemia / Q000209:etiology / Q000628:therapy; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D004032:Diet; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000628:therapy; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D010976:Platelet Count; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy; D013156:Splenectomy
chemical_list: D006454:Hemoglobins; D007501:Iron