Abstract
Background: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. Methods: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. Results: During the study period, 529 patients received RBC transfusion. The median age was 74 (59–85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0–7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29–3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53–3.94), and older age (OR: 1.02/year; 95% CI: 1.01–1.04). Conclusion: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.
Highlights
Blood products are scarce and valuable treatments that rely entirely on donors and should be administered judiciously
The number of red blood cell (RBC) packs transfused in the emergency department (ED) accounted for 4.4% of the total RBC transfused in the participating hospitals during the study period (25,567 RBC packs)
Langlais et al assessed the appropriateness of RBC transfusion in the ED of an academic hospital in France before and after the implementation of a protocol [12]
Summary
Blood products are scarce and valuable treatments that rely entirely on donors and should be administered judiciously. In 2014, the French National Authority for Health published guidelines for red blood cell (RBC) transfusion [2] These recommendations defined RBC transfusion thresholds in limited contexts and settings such as anesthesiology, intensive care, and onco-hematology. A threshold of 7 g/dL was recommended in the intensive care setting, in particular for patients with acute gastro-intestinal bleeding This threshold could be increased to 10 g/dL in cases of acute coronary syndrome or heart failure or in a patient with poor tolerance of anemia (e.g., tachycardia, altered mental status, hypotension, dyspnea). In elderly patients above 80 years of age, the threshold was 7 g/dL, and 8 g/dL in case of history of heart failure or coronary artery disease, or 10 g/dL in cases of poor tolerance These thresholds could be increased in case of rapid onset of anemia. Acute bleeding was observed in the ED for 242 (44.7%)
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