Single Unit Blood Transfusion Guideline for Laboratory Staff Based on the Patient Blood Management Guidelines Be SINGLE minded

Single Unit Transfusion Guideline Applies to: The stable, normovolaemic inpatient who – is NOT actively bleeding – is NOT in an operating theatre Haemoglobin as defined in the Patient Blood Management Guidelines

The Guideline Transfuse one unit, then reassess the patient for clinical symptoms before transfusing another – If the patient’s symptoms are relieved, don’t transfuse more units – Every unit is a new clinical decision – Base decision on patient symptoms, not only on haemoglobin

Single Unit Transfusion Guideline WHY Current practice does not align with evidence-based recommendations Prescribing a single unit of blood may reduce the risk of an adverse event: – Harm from transfusion is dose dependent – Transfusion is an independent risk factor for increased morbidity, mortality and length of stay. There is a lack of evidence for benefit of transfusion in a non-bleeding patient. Five Drivers Shifting the paradigm from Product-focused Transfusion Practice to Patient Blood Management” Axel Hofmann, Shannon Farmer, Aryeh Shander. The Oncologist 2011;16(suppl 3):3-11 Strategies to preempt and reduce the use of blood products: an Australian perspective. Hofmann, A et al. Curr Opin Anesthesiol 2012, 25:66-73.

Be SINGLE minded HOW When blood is ordered for a patient… ASK: – Is the patient actively bleeding? – What is the current haemoglobin? * EXPLAIN: – Only one unit will be issued, in compliance with the Patient Blood Management Guidelines *If Hb <70 g/L a 2 unit request likely to be acceptable Note: Hb<80g/L for patients with acute coronary syndrome Hb<100g/L for renal patients.

Indications for a Second unit Active blood loss Hb < 70g/L for general patients Hb <80g/L for cardiac patients* * See Patient Blood Management Guidelines for other patient groups On going chest pain Less than 8g/L rise in haemoglobin following first unit

Single Unit Transfusion Empowered Staff: Laboratory staff can “gate-keep” compliance. Guideline document is accessible in laboratory – prompt for questions about compliance. Inclusion criteria for a second unit is defined. Support from champions to resolve challenges to requests: (medical staff, haematologists)

Be SINGLE minded Refer disputes to medical staff / champions: Politely suggest that the request is outside the guidelines Re-confirm that the inpatient is NOT actively bleeding or NOT in the operating theatre Provide blood if the patient is bleeding Remain calm, polite and professional, and refer the caller to appropriate medical support staff.

Be SINGLE minded

Single Unit Transfusion Policy Benefits: Safer, evidence based transfusion PLUS: Reduced risk for non-infectious adverse events Reduced demand on limited blood supply Reduced risk from new infectious agents Be SINGLE minded