title: Patient blood transfusion management: discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness.
abstract: BACKGROUND
  Blood transfusion management strategies minimize transfusion-associated risks, enhance outcomes, and reduce costs. We explored an association of discharge hemoglobin (Hb) with pretransfusion Hb, transfusion indications, and red blood cell (RBC) transfusions. We stipulate that patients with discharge Hb concentrations greater than 10.0 g/dL, or even 9.0 g/dL, received excessive RBC transfusions.
  
  
  METHODS
  We examined aggregate data from five hospitals and for one of the hospitals, the focus hospital, we reviewed patient records for a period of 6 months. Data analyses included number of RBC units transfused and Hb values before transfusion, after transfusion, and at discharge.
  
  
  RESULTS
  In aggregate, 27% to 47% patients had discharge Hb levels greater than 10.0 g/dL. At the focus hospital, 27% had a discharge Hb level greater than 10 g/dL and 50.3% had a discharge Hb level greater than 9.0 g/dL. At the focus hospital, the mean Hb trigger for transfusion was a Hb level of 7.3 g/dL; the mean posttransfusion Hb level was 9.3 g/dL and mean discharge Hb level was 9.2 g/dL. Overall, 76% of the transfusions were of an even number of RBC units.
  
  
  CONCLUSIONS
  In aggregate, overutilization exceeded 20%. At the focus hospital, approximately one-quarter of patients receiving transfusions had a Hb concentration greater than 10.0 g/dL at discharge. Transfused patients' discharge Hb concentration represents an effective indicator for retrospective monitoring of transfusion appropriateness. In light of the large number of patients receiving even number transfusions, reviewing Hb levels after transfusion of each RBC unit could reduce unnecessary transfusions. Retrospective review of discharge Hb data focuses providers on transfusion outcomes and affords an educational opportunity for blood utilization management.
authors.affiliation: Department of Pathology, Truman Medical Center, University of Missouri Kansas City School of Medicine, Kansas City, Missouri 64108, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Edwards
authors.forename: Chris
authors.initials: C
authors.lastname: Morrison
authors.forename: Maleeha
authors.initials: M
authors.lastname: Mohiuddin
authors.forename: Vladislav
authors.initials: V
authors.lastname: Tchatalbachev
authors.forename: Charmi
authors.initials: C
authors.lastname: Patel
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Schwickerath
authors.forename: Jay E
authors.initials: JE
authors.lastname: Menitove
authors.forename: Gurmukh
authors.initials: G
authors.lastname: Singh
mesh_terms: D000328:Adult; D001771:Blood Banks / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006470:Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D006784:Hospitals, Teaching / Q000191:economics / Q000592:standards; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics / Q000592:standards*; D011247:Pregnancy; D012189:Retrospective Studies; D012308:Risk Management / Q000191:economics / Q000592:standards; D062606:Tertiary Care Centers / Q000191:economics / Q000592:standards; D014193:Trauma Centers / Q000191:economics / Q000592:standards
chemical_list: D006454:Hemoglobins