Evaluation of the Level of Minimum Hemoglobin Trigger for Red Blood Cell Transfusion according to Clinical Departments

Cho, Jooyoung; Kim, Daewon; Lee, Eunkyung; Kim, Hyun Ok

Abstract

BACKGROUND
Red blood cell (RBC) transfusion is one of the major treatments for correcting anemia, but its use should be carefully considered because of adverse transfusion reactions and inappropriate usage. Therefore, individual health care facilities have self evaluated their use of transfusion in an attempt to decrease unnecessary procedures. In this study, we evaluated the differences in the minimum hemoglobin (Hb) trigger for RBC transfusion among clinical departments in Severance Hospital.
METHODS
We analyzed the electronic medical records of RBC transfusion episodes that were conducted at a Hb level above 8 g/dL from July 2014 to September 2015. We classified these data by clinical department, and considered the overall medical conditions of the patients. The minimum Hb trigger level in this study was defined as the lowest Hb level within 24 hours prior to RBC transfusion.
RESULTS
A total of 4,953 RBC transfusion episodes that were conducted at Hb levels above 8 g/dL were analyzed over that period. In general, the minimum Hb trigger level was higher in the operation group than the hemorrhage group. When compared among clinical departments, the department of orthopedic surgery, neurosurgery, rehabilitation medicine, and anesthesiology showed high levels of minimum Hb trigger equal to or greater than 10 g/dL.
CONCLUSION
The minimum Hb trigger level differed among clinical departments, with the operation group showing a much higher level of minimum Hb trigger. We hope that these data will be practically applied to establish plans and strategies for managing the appropriateness of RBC transfusions in Korea. In addition, continuous evaluation and transfusion education for clinical departments should be performed.