Testing to measure efficacy of a transfusion

A Blood Bank Supervisor at a Regional Medical Center in South Carolina reports that their Transfusion Committee recommends that following the administration of blood products, that testing be done to measure the efficacy of the transfusion. For example, the committee suggests that 1-hour following the transfusion of platelets that a platelet count be obtained; that 4 hours following transfusion of plasma or cryoprecipitate that coagulation testing be done, and that within 24 hours following an RBC transfusion that a Hgb/Hct be measured. She comments that the transfusion committee came up with those numbers without specific literature references and that their hematology department has no such practice recommendations. The South Carolinian wonders what policy/practice is followed at other facilities, and upon what published evidence are these policies based.

The following comments have been received.

ADDENDA July 8, 2007

1. A transfusion medicine physician in New Hampshire comments that determination of the efficacy of a transfusion is a noble effort, although laboratory testing may not be the only or the best way to do this. If the purpose of a transfusion is to modify a number (as in a prophylactic platelet transfusion), then determination of the success of the effort would seem appropriate. One-hour counts are the "traditional" means of determining outcomes (Daly PA, et al. JAMA 1980;243:435-8.), although counts taken 10 minutes after transfusion are just as accurate (O'Connell B, et al. Transfusion 1988;28:66-7) and are more likely to be remembered to be collected by the patient care staff. However, to truly determine efficacy in terms of actual vs. expected response, a CCI would need to be calculated. Similarly for red cell transfusions, one would need to know the hemoglobin content of a unit (based on volume and hemoglobin or hematocrit) in order to determine whether the patient truly achieved the expected outcome rather than just the desired outcome, that is, a particular hemoglobin concentration. Of course, when transfusing for therapeutic benefit, the best approach would be to observe the patient: Did the symptomatology improve? In a non-bleeding patient, hemoglobins may be taken 15-30 min after transfusion to gain an accurate determination. The responding physician knows of no reason why more than a few minute need to elapse following a plasma transfusion and the determination of coagulation parameters. This is unfortunately rarely performed, and, when checked, usually shows a minimal change from the pre-transfusion level unless the parameters were quite abnormal to start with. (Holland LL, et al. Am J Clin Pathol. 2006 Jul;126(1):133-9. Abdel-Wahab OI, et al. Transfusion. 2006;46:1279-85.)

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator