Frequently Asked Questions
If you do not find the answer you are looking for, please send your question to AskTheExpert@sabm.org.
About SABM
- What is SABM?
- What will SABM do for me if I join?
- How can SABM help me move transfusion "medicine mountains" in my institution if I join?
Blood Management/Conservation Programs
- What is "Blood Management"
- Why is Blood Management/Conservation Necessary?
- How can a facility work toward reducing blood transfusions?
- What are the first steps to promoting an organized approach to Blood Management?
- How do you gain physician support?
Blood Substitutes
Blood Transfusion
- When is a blood transfusion indicated in an asymptomatic patient?
- What increase in Hb can be anticipated following the transfusion of 1 unit of PRBC? 0.5, 0.7 or 1 g/dl?
- One of my patients has an Hb of 7.7 g/dl. One unit of autologous RBC was transfused increasing the Hb to 13.1 g/dl. Are these values accurate?
- What thresholds or "transfusion triggers" are used around the USA for RBC and platelet transfusions?
- Our radiology department will not do any procedure... even a PICC line until the INR is less that 1.5. From what I know, INR does not predict bleeding pre-procedure and my concern is that there is too much FFP being given as a direct result of this policy. We want to raise this to 2.0. Do you agree or do you have information on this? What are others doing about INRs and elective procedures?
- So is it safe to do a procedure in a non bleeding patient with an INR of 1.8?
- What is the true cost of a unit of red blood cells?
- What does the medical literature say about the proportion of clinically inappropriate use of fresh frozen plasma in the United States?
- Can you address what the latest indicator is for use of PRBC's with intracranial bleeds? Is the Hgb level still to be maintained greater than 10gm/dl?
- When will an increase in ferritin be seen after a blood transfusion and how much? Additionally, when would reliable ferritin levels be attained after a blood transfusion of PRBC's?
Cell Saver
- Has the "Cell Saver intraoperative cell salvage machine" been successfully used in a patient undergoing ileo-rectal anastomosis?
- Can cell salvage be used on an OB service? How popular is this practice and are there any medicolegal issues.
- Is there a specific title or certification to operate the cell-saver or autotransfusion device? Is this normally a member of the OR staff (in this case) that is cross trained in this discipline.
- I would like to know what SABM's recommendations are for the use of cell salvage during cesarean section. Our OB staff would like to use it for Jehovah Witness patients.
- Is there literature to support the use of the cell saver for washing blood prior to administration of "old blood?"
Epogen
- How is B12 and B6 used with EPO Orders for Emergency Procedures?
- Do you have any information on using EPO prior to a Roux-en-Y bariatric surgery?
- Are there "general" recommendations for preoperative EPO use in JW patients based on age, comorbid conditions, preoperative Hct, and surgical procedure planned?
- For patients that have an iron allergy, are there any products on the market that stimulate RBC production without blood or blood products and no iron? Does EPO contain iron?
- What dose of EPO do you recommend for critically ill patients with a low Hb that refuse transfusion (e.g. Jehovah's Witness)?
- Can you clarify the cost of erythropoieitic stimulating agents (ESA) including EPO, and other blood management strategies along with insurance coverage and pre-authorizations
- What treatment would you recommend for an anemic 49 year old Jehovah Witness with prostate cancer and bone metastasis undergoing ADT therapy? Would you continue with the ADT therapy? Would the EPO and IV iron be of benefit?
- Should a release of liability be obtained for use of EPO beyond recommended guidelines, such as for use when planning for heart surgery?
Iron
- What is the role of IV Iron Dextran in avoiding blood transfusions? What are the risks and benefits of using this approach?
- Is there a list of guidelines for Venofer usage in the non-dialysis patient? I know it is not FDA approved for that, just wondering if there is something out there.
- How can anemia be effectively treated in patients with low hemocrit and RBC count that is not due to iron deficiency? Patient has Medicare, but Procrit is not covered.
Lab
- What is a blood volume study?
- What is the current cost per unit of red blood cells and what has the cost been in the past few years?
- What is the standard for blood collection tubes in a blood conservation/management program?
- What is the standard amount of blood that can be withdrawn from a person over a specified period of time?
- Can you recommend a list of conclusions and outcomes for blood utilization review for comparing data on physician blood use with other facilities?
NovoSeven
Pediatric
Surgery
- How do you prevent postoperative hypothermia and blood loss?
- When must a new pre-surgical blood sample be redrawn?
- What Hemodilution bags are the best to use? Heparin or CPDA-1 and who makes them?
- How is autologous platelet gel made - are there are any alternatives?
- What level of Hb is required to donate autologous blood?
- Does SABM or any other organization have a list of what they would define as excessive bleeding/blood loss/transfusion requirements by procedure?
- Do you know an algorithm that addresses exsanguination in a patient that refuses blood?
Other
- What about the "acquired B" phenomenon? Do the modern monoclonal reagents still pick up acquired B, or is it of historical interest only?
- What care is there for leukemia patients that are Jehovah's Witnesses?
- How long is a signed informed consent for blood transfusion accepted? When does a new consent need to be obtained?