Blood utilization and clinical outcomes in pancreatic surgery before and after implementation of patient blood management

Frank, Steven M.; Lo, Brian D.; Yesantharao, Lekha V.; Merkel, Kevin R.; Qin, Caroline X.; Cho, Brian; Lee, K.H. Ken; Wintermeyer, Tyler L.; Hebbar, Sachin; Burkhart, Richard A.; Goel, Ruchika; Gehrie, Eric A.

doi:10.1111/trf.16063

Cited by 5 publications

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“…31 The findings of this study also bring up important considerations regarding the Choosing Wisely backed practice of prescribing single-unit RBC transfusions, which has become a tenet of patient blood management programs. [32][33][34][35] For non-bleeding hospitalized patients, single-unit RBC transfusions are recommended, followed by a clinical reassessment before additional RBCs are ordered. Though we agree with these guidelines, we encourage providers to also consider the size of the patient when deciding how much blood to transfuse.…”

Section: Discussionmentioning

confidence: 99%

Impact of body weight on hemoglobin increments in adult red blood cell transfusion

Cho

Hensley

et al. 2021

Transfusion

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Background Though weight is a major consideration when transfusing blood in pediatric patients, it is generally not considered when dosing transfusions in adults. We hypothesized that the change in hemoglobin (Hb) concentration is inversely proportional to body weight when transfusing red blood cells (RBC) in adults. Methods A total of 13,620 adult surgical patients at our institution were assessed in this retrospective cohort study (2009–2016). Patients were stratified based on total body weight (kg): 40–59.9 (16.6%), 60–79.9 (40.4%), 80–99.9 (28.8%), 100–119.9 (11.3%), and 120–139.9 (2.9%). The primary outcome was the change in Hb per RBC unit transfused. Subgroup analyses were performed after stratification by sex (male/female) and the total number of RBC units received (1/2/≥3 units). Multivariable models were used to assess the association between weight and change in Hb. Results As patients' body weight increased, there was a decrease in the mean change in Hb per RBC unit transfused (40–59.9 kg: 0.85 g/dL, 60–79.9 kg: 0.73 g/dL, 80–99.9 kg: 0.66 g/dL, 100–119.9 kg: 0.60 g/dL, 120–139.9 kg: 0.55 g/dL; p < .0001). This corresponded with a 35% difference in the change in Hb between the lowest and highest weight categories on univariate analysis. Similar trends were seen after subgroup stratification. On multivariable analysis, for every 20 kg increase in patient weight, there was a ~6.5% decrease in the change in Hb per RBC unit transfused (p < .0001). Conclusions Patient body weight differentially impacts the change in Hb after RBC transfusion. These findings justify incorporating body weight into the clinical decision‐making process when transfusing blood in adult surgical patients.

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