Patient has established cause of chronic anemia (i.e. menorrhagia, iron deficiency, anemia of chronic disease) and is currently symptomatic or has Hgb less than 8
Likely source of anemia has been determined in the ED and appropriate workup has been completed (i.e. fecal occult blood obtained, transvaginal/pelvic ultrasound completed, appropriate consults completed in ED)
Anticipated CDU LOS less than 24 hours
Adequate follow-up and social support anticipated at time of discharge
Unstable vital signs, hypoxia shock, impending respiratory failure or severe systemic illness
Need for more than 2 units of blood cells
Concern for hemolysis
Pancytopenia or neutropenia (If concern for acute bone marrow failure)
Suspicion or knowledge of acute hemorrhage (any source) that is continued or likely to recur
Suspicion of splenic sequestration
Aplastic crisis
Sickle cell patient currently in crisis
Newly diagnosed blood dyscrasia
Further extensive inpatient workup expected (ex bone marrow biopsy, etc)
Labs
CBC with reticulocyte count prior to transfusion if not done in ED or in PCP’s office
Iron Studies (Iron, TIBC, Ferritin) drawn prior to transfusion. Consider Folate, Vitamin B12 as needed.
CBC 30 minutes after last transfusion completed
Medication
Acetaminophen 650 mg 30 minutes prior to transfusion
Benadryl 25 mg PO/IV 30 minutes prior to transfusion
Iron Repletion. If Ferritin < 50, or if Transferrin Sat < 20% AND Ferritin < 300, give Iron Sucrose.
Transfusion
Obtain consent to transfuse or possible need to transfuse if not done in ED.
Irradiated cells only needed if patient has active hematologic malignancy and possible future stem cell transplant (probably excluded from CDU anyway)
Transfuse PRBC over 2 hours for each unit
Vital signs to be done at start of transfusion, 15 minutes into the transfusion, every 30 minutes while infusing, at completion of transfusion
If patient develops reaction during transfusion, stop transfusion immediately and admit patient.
Disposition
Stable and normal vital signs
Improved symptoms 1 hours post transfusion
Stable or improved Hgb/Hct
Follow-up obtained – Primary or Consulting Physician
Development of abnormal vital signs
Worsening symptoms
Worsening Hgb/Hct or non-response to transfusion
Occurrence or recurrence of active acute hemorrhage
Transfusion reaction
New diagnosis requiring hospitalization discovered
Does not or will not meet discharge criteria after 24 hours of treatment
Hospitalization at the discretion of the ED physician, primary physician or consultant