Mair B, Agosti S J, Foulis P R, Hamilton R A, Benson K
Department of Pathology and Laboratory Medicine, University of South Florida College of Medicine, Tampa, USA.
Transfusion. 1996 Jun;36(6):533-5. doi: 10.1046/j.1537-2995.1996.36696269512.x.
Most published reviews and audits of blood and blood component transfusion have focused on the issue of overtransfusion and on the inappropriate use of red cell components. There is growing concern that efforts to curb unnecessary transfusions may result in a trend toward undertransfusion of patients. There is little published information that addresses this issue or the magnitude of this practice.
Undertransfusion was evaluated by examining the transfusion records from a 3-month period for 55 patients who met the study criteria of having either a hemoglobin level < 7 g per dL or a platelet count of < 10 x 10(9) per L. If the identified patient did not receive a transfusion within 24 hours of the reported hemoglobin level or platelet count, the medical record was reviewed by a resident physician.
A total of 213 individual hemoglobin levels and platelet counts, representing the 55 patients, met our transfusion criteria. All except 8 of the identified patients received red cells and/or platelet transfusions. Reasons for not transfusing red cells included the patient's response to nutritional support and iron supplementation, refusal of blood, and noncompliance. Reasons for not transfusing platelets included falsely low platelet count because of platelet clumping in vitro, contraindication based on clinical diagnosis (e.g., immune thrombocytopenic purpura), and the patient's death before transfusion.
Red cell and platelet transfusions were appropriately ordered for all patients who met the transfusion criteria. Undertransfusion is not a problem at this institution according to the criteria established. It is recommended that other institutions expand their blood utilization audits to include investigation for evidence of undertransfusion. Further research regarding the issue of undertransfusion is warranted and could be expanded to include other components.
大多数已发表的关于血液及血液成分输血的综述和审计都聚焦于过度输血问题以及红细胞成分的不当使用。人们越来越担心，抑制不必要输血的努力可能会导致患者输血不足的趋势。关于这个问题或这种做法的程度，几乎没有公开的信息。
通过检查55名符合研究标准（血红蛋白水平<7 g/dL或血小板计数<10×10⁹/L）患者的3个月输血记录来评估输血不足情况。如果已识别的患者在报告的血红蛋白水平或血小板计数后24小时内未接受输血，则由住院医师审查病历。
代表55名患者的总共213次个体血红蛋白水平和血小板计数符合我们的输血标准。除8名已识别患者外，所有患者均接受了红细胞和/或血小板输血。不输注红细胞的原因包括患者对营养支持和铁补充的反应、拒绝输血以及不依从。不输注血小板的原因包括体外血小板聚集导致的血小板计数假性降低、基于临床诊断的禁忌证（如免疫性血小板减少性紫癜）以及患者在输血前死亡。
对于所有符合输血标准的患者，红细胞和血小板输血的医嘱都是合适的。根据既定标准，在本机构输血不足不是问题。建议其他机构扩大其血液利用审计范围，包括调查输血不足的证据。关于输血不足问题的进一步研究是有必要的，并且可以扩展到包括其他成分。
