title: Inappropriate Packed RBC Transfusion in a Tertiary Care Center.
abstract: BACKGROUND
  Transfusion of packed red blood cells (pRBC) with appropriate indications is not only important for patient safety and well-being but is also crucial for proper utilization of resources and health care-related cost reduction. We aimed to investigate the clinical appropriateness of blood transfusion in Shariati Hospital, one of the largest academic medical centers in Tehran.
  
  
  METHODS
  In this prospective observational study, 1000 transfusions of allogenic pRBCs from April 1st to October 31st, 2015 were included. The patients' characteristics, reason for hospitalization, indications for pRBC transfusions and ordering wards were collected.
  
  
  RESULTS
  The mean level of hemoglobin before transfusion was 7.4 ± 2.3 g/dL in the emergency department, 7.5 ± 1.0 g/dL in medical wards, 10.4 ± 2.6 g/dL in surgical wards, and 9.1 ± 2.2 g/dL in the intensive care unit. The baseline hemoglobin levels differed significantly between the departments (P < 0.001). Approximately 22% (219 patients) with hemoglobin level ≥ 10 g/dL received pRBC, which appeared to be unnecessary and inappropriate.
  
  
  CONCLUSIONS
  Despite current international guidelines emphasizing the importance of restricted transfusion policy, the transfusion of pRBC with insufficient indications occurred frequently in Shariati Hospital, particularly in surgical wards.
authors.affiliation: Assistant Professor of Medicine, Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Anahita
authors.initials: A
authors.lastname: Sadeghi
authors.affiliation: General Practitioner, Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Safieh
authors.initials: S
authors.lastname: Belali
authors.affiliation: Assistant Professor of Medicine, Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ali Asgari
authors.affiliation: Nurse, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Morovat
authors.affiliation: Professor of Medicine, Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
authors.affiliation: Associate Professor of Medicine, Pharmacology and Experimental Therapeutics; Director, Hematology and Medical Oncology Fellowship, University of Maryland School of Medicine, Marlene and Stewart Greenebaum.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Emadi
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000458:organization & administration; D017707:Erythrocyte Transfusion / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007492:Iran; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms / Q000458:organization & administration; D011446:Prospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration*
chemical_list: D006454:Hemoglobins