E A Gehrie1, N H Roubinian2,3, D Chowdhury4, D J Brambilla4, E L Murphy2,3, J L Gottschall5,6, Y Wu7,8, P M Ness1, R G Strauss9, J E Hendrickson7. 1. Johns Hopkins School of Medicine, Baltimore, MD, USA. 2. University of California, San Francisco, CA, USA. 3. Blood Systems Research Institute, San Francisco, CA, USA. 4. RTI International, Rockville, MD, USA. 5. Blood Center of Wisconsin, Milwaukee, WI, USA. 6. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA. 7. Yale University, New Haven, CT, USA. 8. Bloodworks Northwest, Seattle, WA, USA. 9. Institute of Transfusion Medicine, Pittsburgh, PA, USA.
Abstract
BACKGROUND AND OBJECTIVES: Many hospitals require transfusions to be discontinued when vital signs stray from predetermined ranges, regardless of clinical symptoms. Variations in vital signs may be unrelated to transfusion, however, and needlessly stopping a transfusion may delay medical care while increasing donor exposures and healthcare costs. We hypothesized that a detailed study of vital sign changes associated with transfusion of blood product by component, including those associated with potential reactions (complicated) and those deemed to be uncomplicated, would establish a useful framework of reference for treating clinicians and transfusion services alike. MATERIALS AND METHODS: A retrospective electronic record review of transfusion service and transfusion recipient data was completed on 3852 inpatient transfusion episodes over a 6-month period at four academic tertiary care hospitals across the United States. Vital signs pre- and post-transfusion were recorded by trained clinical research nurses. Serious reactions were adjudicated by a panel of transfusion medicine experts. RESULTS: In both uncomplicated transfusions (n = 3765) and those including an adverse reaction (n = 87), vital sign fluctuations were generally modest. Compared to uncomplicated transfusions, transfusions complicated by febrile reactions were associated with higher pretransfusion temperature and higher pretransfusion pulse rates. Episodes of transfusion circulatory overload were associated with higher pretransfusion respiration rates compared to uncomplicated transfusions. CONCLUSION: Most transfusions are associated with only modest changes in vital signs. Pretransfusion vital signs may be an important yet previously understudied predictor of vital sign changes during transfusion. The optimal role of vital sign assessment during blood transfusion deserves further study.
BACKGROUND AND OBJECTIVES: Many hospitals require transfusions to be discontinued when vital signs stray from predetermined ranges, regardless of clinical symptoms. Variations in vital signs may be unrelated to transfusion, however, and needlessly stopping a transfusion may delay medical care while increasing donor exposures and healthcare costs. We hypothesized that a detailed study of vital sign changes associated with transfusion of blood product by component, including those associated with potential reactions (complicated) and those deemed to be uncomplicated, would establish a useful framework of reference for treating clinicians and transfusion services alike. MATERIALS AND METHODS: A retrospective electronic record review of transfusion service and transfusion recipient data was completed on 3852 inpatient transfusion episodes over a 6-month period at four academic tertiary care hospitals across the United States. Vital signs pre- and post-transfusion were recorded by trained clinical research nurses. Serious reactions were adjudicated by a panel of transfusion medicine experts. RESULTS: In both uncomplicated transfusions (n = 3765) and those including an adverse reaction (n = 87), vital sign fluctuations were generally modest. Compared to uncomplicated transfusions, transfusions complicated by febrile reactions were associated with higher pretransfusion temperature and higher pretransfusion pulse rates. Episodes of transfusion circulatory overload were associated with higher pretransfusion respiration rates compared to uncomplicated transfusions. CONCLUSION: Most transfusions are associated with only modest changes in vital signs. Pretransfusion vital signs may be an important yet previously understudied predictor of vital sign changes during transfusion. The optimal role of vital sign assessment during blood transfusion deserves further study.
Authors: Jeanne E Hendrickson; Nareg H Roubinian; Dhuly Chowdhury; Don Brambilla; Edward L Murphy; Yanyun Wu; Paul M Ness; Eric A Gehrie; Edward L Snyder; R George Hauser; Jerome L Gottschall; Steve Kleinman; Ram Kakaiya; Ronald G Strauss Journal: Transfusion Date: 2016-07-26 Impact factor: 3.157
Authors: Chester Andrzejewski; Mark A Popovsky; Theresa C Stec; Jean Provencher; Lynne O'Hearn; Paul Visintainer; Jay Steingrub Journal: Transfusion Date: 2012-03-12 Impact factor: 3.157
Authors: Karen E King; R Sue Shirey; Sandra K Thoman; Debra Bensen-Kennedy; Warren S Tanz; Paul M Ness Journal: Transfusion Date: 2004-01 Impact factor: 3.157