Updated Red Blood Cell Transfusion Guidlines
As part of a hospital-wide effort to improve the evidence-based
nature of the care we provide, BWH has revised the red blood cell (RBC)
transfusion guidelines.
This past fall, a multidisciplinary group of clinical leaders and
transfusion experts came together to review and revise the existing BWH
RBC transfusion guidelines. All clinical departments have agreed to the
updated guidelines below, which were incorporated into BICS order entry
decision support on Jan. 10. Because the appropriate use of blood
products is of critical importance to our patients, to society, and to
hospital finances, all BWH department chairs have agreed to follow these
guidelines.
“We believe these guidelines apply to the majority of BWH patients,
but we of course recognize that there may be individual patients with
unique clinical circumstances who require deviation from these
guidelines,” said Chief Medical Officer Stan Ashley, MD. “In those
instances, ordering clinicians can override the decision support and
indicate their reason for doing so.”
Additionally, as part of an effort to improve communication between
faculty and house staff regarding critical clinical decisions, all
attendings will begin receiving automated emails from BICS at the moment
that any of their patients receive an order for an RBC transfusion
outside of BWH guidelines. The email will include the patient’s MRN and
name as well as the name of the ordering clinician and a link to that
clinician’s entry in the paging directory. After receiving such an
email, an attending will have enough time to contact the ordering
clinician and discuss the transfusion before the blood bank fulfills the
order. These emails to facilitate better communication and provide
important clinical education for our trainees.
Revised BWH RBC Transfusion Guidelines:
Clinical Indication |
Hematocrit Threshold below which RBC Transfusion may be Indicated |
- Active Bleeding
- Rehabilitation facility requires higher Hct prior to discharge from BWH
- Symptomatic Anemia
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|
- Congenital heart disease associated with chronic cyanosis and O2 saturation between 73-82%
|
|
- Congenital heart disease associated with chronic cyanosis and O2 saturation between 83-93%
|
|
- Active cardiac ischemia, not revascularized
- Cerebral vasospasm secondary to subarachnoid hemorrhage (as documented by CTA or digital cerebral angiography)
- Cervical cancer and receiving XRT
- Extracorporeal photopheresis
|
|
- Recent extrapleural pneumonectomy or pleurectomy or recent lung
resection and (a) expected post-op FEV1<40%, or (b) expected post-op
DLCO<40%, or (c) evidence of pulmonary hypertension on TTE or TEE
|
|
- Pregnant Patient
- Pre-operative anemia with expected blood loss >50mL
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- Malignancy and impaired or anticipated impaired hematopoiesis
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- Post-op anemia due to blood loss
- Normovolemic, non-bleeding & none of above
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