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KMID : 0387720180290020151
Korean Journal of Blood Transfusion
2018 Volume.29 No. 2 p.151 ~ p.158
Evaluation of Hemoglobin Trigger and Appropriateness of Perioperative Red Cell Transfusion in Surgical Departments
Yang Mi-Na

Kim Hoon-Seok
Lee Jong-Mi
Jung Jin
Choi Seung-Jun
Lim Ji-Hyang
Abstract
Background: Red blood cell (RBC) transfusion is an essential practice during surgery to accommodate for bleeding. As such, there are efforts being made to allow for a safe and appropriate transfusion due to shortages of blood components and to minimize transfusion-related adverse reactions. However, a conventional transfusion decision with relatively high hemoglobin (Hb) threshold is still performed in clinical setting. In this study, we investigated the threshold of Hblevel and appropriateness of RBC transfusion in patients receiving perioperative RBC transfusion in surgical departments.



Methods: We investigated the pre-transfusion Hb level of 1,379 patients (2,170 episodes) receiving perioperative RBC transfusion in five surgical departments, including cardiothoracic surgery (CS), general surgery (GS), neurosurgery (NS), obstetrics and gynecology (OBGY), and orthopedics (OS), between June 2017 and March 2018. The appropriateness of transfusion was evaluated with two criteria: 1) pretransfusion Hb level ¡Â10 g/dL and 2) posttransfusion Hb level ¡Â10 g/dL.


Results: The median pretransfusion Hb level was 8.5 g/dL (interquartile range 7.7¡­9.4); that of each department was as follows: 8.6 g/dL (7.9¡­9.2) in CS, 7.9 g/dL (7.3¡­8.6) in GS, 9.1 g/dL (8.5¡­9.8) in NS, 8.5 g/dL (7.7¡­9.8) in OBGY, and 8.7 g/dL (7.9¡­9.7) in OS. With a criteria of pretransfusion of Hb level ¡Â10 g/dL, 85.4% of total episodes were appropriate. With criteria of post-transfusion of Hb level ¡Â10 g/dL, 44.7% were appropriate.

Conclusion: This study presents a fundamental data observing the trend of RBC transfusion in a single institution. A significant proportion of inappropriate RBC transfusion are still being conducted in surgical setting.

Continuous and effective education of clinicians and implementation of monitoring systems to assess the appropriateness of RBC transfusion may be necessary.
KEYWORD
Hemoglobin, Trigger, Appropriateness, Red blood cell transfusion, Surgery
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