Discharge home after ED Blood Transfusion

[blackadder]

This has recently come up in my group--who can you safely send home after transfusing in the ED?

Anybody willing to share what you do in your shop or have a magical set of guidelines they'd be willing to share?

Thanks

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[RustedFox]

Sickle cell anemia patient who "has done this before" = transfuse 1 unit, DC home with follow-up by heme/onc.

Any comorbidities = admit.

 

[shookwell]

You can do this for the right patients with good followup, as long as your ED lets you keep patients in the ED for the amount of time it takes. I do this regularly.

Many of these patients are perfect for ED obs units if you have that or you are under pressure from admin to decrease dispo times.

 

[gutonc]

I've taken a few of these calls on my group's patients.

Somebody with a known cause for their anemia (MDS, other malignancy with chemo induced anemia) and prior transfusion(s) without incident/reaction? If you're otherwise OK with them going home, so am I. And we'll see them the next day (including weekends/holidays as we have a treatment unit open 365 days a year that is staffed with a PA/NP with MD backup).

Any unclear reason for anemia, other cytopenias or other reasons to be sick that a few red cells won't fix? They need to come in.

 

[Groove]

I hate the ESRD dumps for blood transfusion because their nephrologists are too troubled to do it in the dialysis center. Most of the time I refuse to do it if their HCT is acceptable. Total abuse of resources.

 

[CommunityED]

We can't. By law (or regulation, not sure exactly which one) in MA, in order to discharge a patient after blood transfusion, you have to be a licensed transfusion center. The ER is not. They all get admitted. Also, I'm not tying up a bed for the 4-6 hours that this takes.

 

[shookwell]

We can't. By law (or regulation, not sure exactly which one) in MA, in order to discharge a patient after blood transfusion, you have to be a licensed transfusion center. The ER is not. They all get admitted. Also, I'm not tying up a bed for the 4-6 hours that this takes.

Laws are dumb

I'm glad I mostly work in places where I don't care about that. I'm perfectly happy keeping someone in the ED for 10-15 hours without admitting them if that's what's best for them.

 

[Janders]

We can't. By law (or regulation, not sure exactly which one) in MA, in order to discharge a patient after blood transfusion, you have to be a licensed transfusion center. The ER is not. They all get admitted. Also, I'm not tying up a bed for the 4-6 hours that this takes.

Could you find that info from your admin for me? I've worked a few places in MA, and have certainly placed people in observation in the ED, transfused them, and discharged. Sometimes there isn't space, and sometimes they need further workup, but SOMETIMES it makes sense. There is no difference in placing someone in ED OBS than placing in observation in room 342 on a hospitalist service-- they are still outpatients and have the same rules/regs applied.

The MA regs state transfusions need to be done by a transfusion service in a hospital setting (with some exceptions-- ESRD @ HD center, etc) but the blood I give in my ED IS overseen by a transfusion service in a hospital setting...

 

[emergentmd]

I do it all the time. Stable patients with mild symptomatic anemia that saves an admission.

Sickle Cell pts
Chronic anemia from menstrual cycles
Chronic anemia from whatever the source

What is the point of admitting a chronic anemic that is stable, hgb of 6 that missed their transfusion b/c clinic is closed? Admit them overnight for a unit of blood taking 2 hrs to transfuse?

 

[BJJVP]

At what rate do you guys transfuse blood in stable pts? I have always done 1 unit over 4 hrs. Do you guys go faster in pt's with a known healthy heart? What if they have an echo that demonstrated grade I diastolic dysfunction? What about FFP?

 

[gutonc]

At what rate do you guys transfuse blood in stable pts? I have always done 1 unit over 4 hrs. Do you guys go faster in pt's with a known healthy heart? What if they have an echo that demonstrated grade I diastolic dysfunction? What about FFP?

Assuming no significant heart history, 1U/2h. Can push it a little more in the young.

FFP can go in faster than it took the nurse to get the IV.

 

[shookwell]

Who cares. I let the nurses decide. Makes them happy and doesn't matter at all.

 

[shoal007]

2 different states and hospitals, 1unit over 4 hours prbc


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[Aesculapius]

If the patient has a clear reason for why they have anemia that doesn't involve ongoing losses (e.g., GI bleeding), only needs 1 unit, and are otherwise without significant complaints and have normal VS, I do discharge them. If they need more than 1 unit, or their cause of anemia isn't clear, I admit.