Strategies to Decrease Blood Utilization and Improve Safety. Presented by Paul McLoone, M.D. April 17, 2012. History of RBC transfusion “triggers”. To mid-1980s: 10 g/dL hemoglobin Conservative trend in 1980s and ff. TTDs (HIV and NANB hepatitis (HCV)) Shortages
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Paul McLoone, M.D.
April 17, 2012
Few RCTs (garbage in, garbage out)
Observational cohorts, case series, expert opinion
Unstudied populations affect generalizability
Key functional outcomes generally not availableHow are triggers “set”?
Death from general anesthesia
Death from medical error
Death from hosp. infect.
Bacteria in platelets
Modified from S. Dzik, MD Blood Transfusion Service MGH, Boston.
Zilberberg, M. BMC Health Services Res. 2007.
TSACs/unit RBC/US ICUs
Source: D Devine et al.: International Forum/Inventory Management, Vox Sanguinis 2009
Shander et al. Transfusion. 2010.
*Transfusion Requirements In Critical Care. Hebert et al. NEJM. 1999.
Hebert, P et al. Crit. Care Med. 2001
Hebert, P et al. Chest. 2001
*Functional Outcomes in Cardiovascular patients Undergoing Surgical hip fracture repair (clinicaltrials.gov NCT00071032 )