Background
Blood transfusions though life‐saving are not entirely benign. They are the most overused procedure in the hospital and have been under scrutiny by the ‘Choosing Wisely campaign’. The strict adoption of restrictive transfusion guidelines could improve patient outcomes while reducing cost.
Objectives
In this study, we evaluate adherence to restrictive transfusion guidelines, along with hospital mortality and length of stay (LOS) in transfusion events with a pre‐transfusion haemoglobin (Hb) ≥7 g/dl. Additionally, we evaluated associated costs accrued due to unnecessary transfusions.
Methods
We conducted a retrospective observational study in a 64‐bed medical intensive care unit (MICU) of an academic medical centre involving all adult patients (N = 957) requiring packed red blood cell transfusion between January 2015 and December 2015.
Results
In total, 3140 units were transfused with a mean pre‐transfusion Hb of 6.75 ± 0.86 g/dl. Nine hundred forty‐four (30%) transfusion events occurred with a pre‐transfusion Hb ≥7 g/dl, and 385 (12.3%) of these occurred in patients without hypotension, tachycardia, use of vasopressors, or coronary artery disease. Forgoing them could have led to a savings of approximately 0.3 million dollars. Transfusion events with pre‐transfusion Hb ≥7 g/dl were associated with an increased mortality in patients with acute blood loss (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11–3.88; p = 0.02) and LOS in patients with chronic blood loss (β1.8.26, 95% CI 4.09–12.43; p < 0.01).
Conclusion
A subset of anaemic patients in the MICU still receive red blood cell transfusions against restrictive guidelines offering hospitals the potential for effective intervention that has both economic and clinical implications.
A pancreatic pseudocyst is a complication of abdominal trauma in pediatric patients. Octreotide acetate is an effective adjunct therapy used in combination with traditional surgical approaches. We describe a 19-month-old boy with a pancreatic pseudocyst secondary to blunt abdominal trauma who was successfully managed with octreotide acetate in combination with percutaneous drainage and the placement of a pancreatic stent. Octreotide acetate 1 μg/kg/hour was administered as a continuous intravenous infusion for 24 hours, followed by 2.5 μg/kg/dose every 12 hours subcutaneously for 11 days. The patient was discharged after the pseudocyst had resolved and oral feeding was restored. He had no recurrence of the pseudocyst. The published literature regarding octreotide acetate therapy for pediatric pancreatic pseudocysts is limited. Previously reported cases demonstrated successful resolution of pancreatic pseudocysts with varying doses of intravenous and subcutaneous octreotide acetate within 23-30 days; however, with our patient's regimen, along with surgical interventions, the pseudocyst resolved within 11 days. In addition, our patient's regimen involved higher doses of octreotide acetate given more frequently than those reported in the literature. This case report illustrates that use of higher octreotide acetate dosages may be a potential adjunct therapy to surgical interventions for the management of pancreatic pseudocysts in children.
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