title: Clinical factors influencing the decision to order red blood cell transfusions for a sample of US dialysis patients .
abstract: OBJECTIVE
  To characterize the clinical context for the decision to order red blood cell (RBC) transfusions in dialysis patients.
  
  
  METHODS
  Retrospective review of medical records from three integrated health systems serving chronic dialysis patients. Subjects were randomly selected from all patients who received at least one transfusion between January 2009 and December 2013. Data abstracted included transfusion setting, prescribing clinician type, patient demographics and hemoglobin (Hb) concentration prior to transfusion, and cataloguing and prioritizing of clinical factors for their contribution to the decision to transfuse. Data from one system were stratified between transfusions before and after the 2011 dialysis payment reform and anemia drug label changes.
  
  
  RESULTS
  Charts for 590 patients were reviewed. The primary reason for transfusion was low Hb (51%), medical conditions (22%), symptoms of anemia (18%), surgery-related (6%), and undetermined (3%). In 93% of cases, multiple factors were cited as contributors to the transfusion decision. Mean Hb prior to transfusion was 7.2 g/dL in patients where low Hb was the primary reason for transfusion (range: 4.0 - 9.9 g/dL).
  
  
  CONCLUSIONS
  The decision to transfuse dialysis patients is influenced by multiple patient factors and medical conditions, of which low Hb is the main contributor to this decision about half of the time. .
authors.forename: J Mark
authors.initials: JM
authors.lastname: Stephens
authors.forename: John P
authors.initials: JP
authors.lastname: Caloyeras
authors.forename: John
authors.initials: J
authors.lastname: Holmen
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Kumar
authors.forename: Spiros
authors.initials: S
authors.lastname: Tzivelekis
authors.forename: Allan
authors.initials: A
authors.lastname: Pollock
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D000066491:Clinical Decision-Making; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins; D006470:Hemorrhage / Q000150:complications / Q000628:therapy; D006801:Humans; D007430:Intraoperative Care; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D008297:Male; D011182:Postoperative Care; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins