MONITORING FOR UNDERTRANSFUSION

Background: Most published reviews and audits of blood and blood compo nent transfusion have focused on the issue of overtransfusion and on t he inappropriate use of red cell components. There is growing concern that efforts to curb unnecessary transfusions may result in a trend to ward undertransfusion of patients. There is little published informati on that addresses this issue or the magnitude of this practice. Study Design and Methods: Undertransfusion was evaluated by examining the tr ansfusion records from a 3-month period for 55 patients who met the st udy criteria of having either a hemoglobin level <7 g per dL or a plat elet count of <10 x 10(9) per L. If the identified patient did not rec eive a transfusion within 24 hours of the reported hemoglobin level or platelet count, the medical record was reviewed by a resident physici an. Results: A total of 213 individual hemoglobin levels and platelet counts, representing the 55 patients, met our transfusion criteria. Al l except 8 of the identified patients received red cells and/or platel et transfusions. Reasons for not transfusing red cells included the pa tient's response to nutritional support and iron supplementation, refu sal of blood, and noncompliance. Reasons for not transfusing platelets included falsely low platelet count because of platelet clumping in v itro, contraindication based on clinical diagnosis (e.g., immune throm bocytopenic purpura), and the patient's death before transfusion. Conc lusion: Red cell and platelet transfusions were appropriately ordered for all patients who met the transfusion criteria. Undertransfusion Is not a problem at this institution according to the criteria establish ed. It is recommended that other institutions expand their blood utili zation audits to include investigation for evidence of undertransfusio n. Further research regarding the issue of undertransfusion is warrant ed and could be expanded to include other components.