北京协和医院非手术科室红细胞输注前血红蛋白高于推荐阈值患者的临床特点

  目的  探讨北京协和医院非手术科室红细胞输注前血红蛋白高于输血指南推荐阈值患者的临床特点。  方法  对2013年1月至12月在北京协和医院住院期间行红细胞输注的患者随机抽样1000例, 筛选出红细胞输注前血红蛋白值≥ 70 g/L的非手术科室患者的资料, 对其红细胞输注前血红蛋白、在非手术科室红细胞输注患者中所占比例、输血前与贫血相关的症状及体征等进行描述性分析。  结果  住院期间接受红细胞输注的非手术科室患者270例, 红细胞输注前平均血红蛋白(63.7±11.5)g/L, 其中红细胞输注前血红蛋白≥ 70 g/L者74例(27.4%), 包括血红蛋白≥ 70 g/L且 < 80 g/L者60例(22.2%), 血红蛋白≥ 80 g/L且 < 90 g/L者10例(3.7%)和血红蛋白≥ 90 g/L者4例(1.5%)。74例患者中, 59例(79.7%)在病程记录中描述了与输血相关的症状、体征及红细胞输注临床决策, 未描述的15例(20.3%)均为原发病较重、合并症多、可能伴有多系统受累和临床状况不稳定、对血红蛋白下降耐受较差的患者。  结论  北京协和医院非手术科室红细胞输注前血红蛋白阈值基本符合国际输血指南和我国《临床输血技术规范》所推荐范围。结合红细胞输注前血红蛋白高于指南推荐阈值患者的具体病情, 其输血具有临床合理性, 但在今后的临床记录中应对临床输血决策进一步给予详细的描述与分析。

Clinical Characteristics of Patients with Hemoglobin Level before Red Blood Cell Transfusion Higher than Recommended Threshold in Non-surgical Departments of Peking Union Medical College Hospital

  Objective  To investigate the clinical characteristics of patients with hemoglobin level higher than the recommended threshold by guidelines before receiving red blood cell (RBC) transfusion in non-surgical departments of Peking Union Medical College Hospital (PUMCH).  Methods  One thousand patients were randomly selected from hospitalized patients who received RBC transfusion at PUMCH between January and December in 2013. Among them, those in non-surgical departments and with hemoglobin ≥ 70 g/L before transfusion were identified, and their hemoglobin level before RBC transfusion, proportion in non-surgical patients receiving RBC transfusion, symptoms and signs related to anemia before transfusion were described.  Results  Of the 1000 patients, 270 were from non-surgical departments, and their average hemoglobin before RBC transfusion was (63.7±11.5)g/L. Seventy-four of the 270 (27.4%) patients had hemoglobin ≥ 70 g/L before RBC transfusion, including 60 (22.2%) patients with homoglobin ≥ 70 g/L and < 80 g/L, 10 (3.7%) patients with homoglobin ≥ 80 g/L and < 90 g/L, and 4 (1.5%) patients with hemoglobin ≥ 90 g/L. Among the 74 patients, symptoms and signs related to anemia and decision-making of the transfusion were identified in 59(79.7%) patients' medical records, the other 15(20.3%) patients with missing data were those with more severe conditions, multiple co-morbidities, multi-organ involvement, unstable conditions, or poor tolerance to decreasing hemoglobin level.  Conclusions  The hemoglobin threshold for RBC transfusion in non-surgical departments of PUMCH was consistent with the recommendations of both international and Chinese guidelines. Given specific conditions, RBC transfusion in those patients with hemoglobin level higher than the recommended threshold is clinically appropriate, but the decision-making process regrading RBC transfusion should be recorded in detail.