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Old Tue Apr 26, 2016, 08:33 AM
Greg H Greg H is offline
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Join Date: Sep 2010
Location: North Carolina
Posts: 660
The Insanity of "Hospital Policy"

I was admitted to Stanly Regional Medical Center [SRMC] last night, because of fever, and promptly pumped full of fluids, along with a bag of platelets, 2 grams of Vancomycin, 2 grams of Cefepime, and some amount of Zosyn.

I have had only one platelet transfusion, and, in that instance, I was being prepped for surgery and was pumped full of morphine. I wasn't paying close attention.

So, I was surprised when my nurse brought me, a B+ patient, a bag of B- platelets. I went to the mighty Google immediately, and discovered that Rh factor is pretty much not a concern where platelet transfusions are concerned, and the the whole ABO thing is not much of an issue either. I was surprised, but you live and learn.

On to my rant for today. My very bright young nurse this morning, as we discussed my treatment plan for the day, explained that the previous policy at SRMC had been to transfuse below HGB 8.0. But they have merged with a larger hospital network centered in Charlotte, and the new policy is to transfuse at HGB below 7.0.

Now, I love the fact that my little country hospital (They serve grits with breakfast! ) is part of a big, fancy network. When I had acute necrotic pancreatitis in April of last year, after a week here at SMRC, the local surgeon and hospitalist decided to move me down to CMC Main in Charlotte, where I was attended to by one of the top five Hepatopancreaticobiliary surgical teams in the world. All seamlessly, with records instantly accessible through the network. (The ride in a box EMS ambulance in bad need of shocks was less than pleasant, but that is why God made morphine.)

But I do not love the notion that a bunch of folks running the medical policy committee at CMC have decided to drop the transfusion standard by a point. And I do not love the fact that the standard is applied to all patients, whether they are in surgery or just poor unfortunate blokes with bone marrow failure, like me.

Here's the deal, as I see it: It makes no difference in terms of the utilization of scarce and expensive blood products at what HGB level you decide to transfuse a bone marrow failure patient -- because we are going to need the blood anyway!

If the state of my marrow means I need blood every other week, you can transfuse me at 7.0 and I will need two units in two weeks. You can transfuse me at 8.0, and I will need two units of blood in two weeks. You can transfuse me a 12.0, and I will need two units of blood in two weeks.

That's just a fact.

So, when it comes to treating bone marrow failure patients, wouldn't it make sense to transfuse us at a level that makes us comfortable and productive citizens?

I am one of the lucky fools who can get along just fine with HGB in the high sixes. But, back when Danazol was still working for me, I truly enjoyed life in the elevens.

I'm not suggesting that I should be transfused to keep me in the elevens. But I do recall a research nurse at NIH telling me they transfuse older patients (and let's face it, most of us MDS folks aren't Spring chickens) to keep them above 9.0. That would be a blessing, in my estimation.

Okay, rant over, But I am curious: what's the standard transfusion level at your hospital or doctor's office?

And second, maybe we need to band together or get the folks at AAMDS or LLS involved in bringing some rationality to transfusion policies for bone marrow failure patients. I think I'll try to watch that new transfusion webinar over at AAMDS and see whether the presenter addresses the issue. That might be a place to start.
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Greg, 59, dx MDS RCMD Int-1 03/10, 8+ & Dup1(q21q31). NIH Campath 11/2010. Non-responder. Tiny telomeres. TERT mutation. Danazol at NIH 12/11. TX independent 7/12. Pancreatitis 4/15. 15% blasts 4/16. DX RAEB-2. Beginning Vidaza to prep for MUD STC. Check out my blog at www.greghankins.com
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