title: Is undertransfusion a problem in modern clinical practice?
abstract: BACKGROUND
  Significant progress has been made in reducing inappropriate transfusion of blood products. However, there is also a need to monitor for their underutilization in patients who would benefit from transfusion. This study aimed to develop a method to monitor for undertransfusion and conduct a preliminary examination of whether it is a problem in modern clinical practice.
  
  
  METHODS
  All patients with a hemoglobin (Hb) concentration below 6 g/dL or platelet (PLT) count of fewer than 10 × 10(9) /L were identified during a 1-month period in an academic medical center in the United Kingdom. Patients who were transfused within 72 hours of the low reading were excluded from further analysis. For all other patients, records were examined against predefined criteria to ascertain whether the reason for nonadministration of transfusion was justified.
  
  
  RESULTS
  During the study period there were 63 eligible Hb readings and 130 eligible PLT counts in 93 patients. Of these, 36 patients were not transfused within 72 hours of the low reading. The majority of nonadministration (n = 28) was justified by either an additional Hb or an additional PLT count on repeat sampling being above the transfusion threshold or the transfusion being medically inappropriate. No documentation was found to indicate that any cases of nonadministration of blood were unjustified.
  
  
  CONCLUSIONS
  This study did not find that patients with low Hb readings or PLT counts were inappropriately undertransfused. However, systems similar to those described in this study should be developed to monitor for inappropriate undertransfusion as well as continuing efforts to monitor for and reduce inappropriate overtransfusion.
authors.affiliation: Oxford University Clinical Academic Graduate School, Oxford, UK.|NHS Blood & Transplant, Oxford, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hibbs
authors.affiliation: Oxford University Hospitals (OUH) NHS Trust, Oxford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Miles
authors.affiliation: Oxford University Hospitals (OUH) NHS Trust, Oxford, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Staves
authors.affiliation: NHS Blood & Transplant, Oxford, UK.|National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals and the University of Oxford, Oxford, UK.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D000740:Anemia / Q000097:blood / Q000628:therapy; D001803:Blood Transfusion / Q000706:statistics & numerical data* / Q000639:trends; D006454:Hemoglobins / Q000032:analysis; D006785:Hospitals, University / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D010976:Platelet Count; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D055656:Prescriptions / Q000706:statistics & numerical data; D013921:Thrombocytopenia / Q000097:blood / Q000628:therapy; D016312:Treatment Refusal / Q000706:statistics & numerical data; D006113:United Kingdom; D028761:Withholding Treatment / Q000706:statistics & numerical data
chemical_list: D006454:Hemoglobins