Critical Hgb value changed

I'm doing a travel assignment and the hospital just implemented a new policy that the critical Hgb value has changed to < 7. If a physician orders a blood transfusion for a Hgb > 7 they must fill out additional paperwork choosing from a list of approved indications. Just curious if anyone else has seen this and also what the rationale may be for not transfusing above 7. I haven't seen any inservicing for nurses on the policy in this facility.
It's because of the blood shortage. We've gone from transfusing below 9 to transfusing below 8, and 7's coming.

Thanks for the reply. Seriously as soon as I posted this I walked out to the nurses station and found the information about why this happened, lol. Apparently, our facility says that the trend is going to transfuse at 7 or below because the risk is higher than the benefit above 7. Not surprisingly it also has to do with the fact that medicare and other insurances won't pay for adverse events r/t transfusions that were unnecessary or errors made on the hospitals part.

Our hospital made the same changes and we had to complete a very long in-service related to it. Ours physicians are ignoring it and transfusing anyone under 8.0, though.

I think the justification is to prevent a build up of anti-bodies where possible and to try and increase the HB with other ways rather than relying on transfusions.

Recent studies have been released showing increased mortality with blood transfusions. I know one study in particular related to cardiac surgery patients (my patient population) which is now the guidelines are surgeons follow. None of them transfuse based strictly on the numbers, the patient must be actively bleeding or symptomatic. Our facility has adopted new transfusion guidelines as well

http://www.medscape.com/viewarticle/549791Here's one study...you have to sign up for meds ape but registration is free

wow we transfuse for <9 - I wish we would change it to <7 or even 8, I hate transfusing blood!

We don't transfuse until they're <7 either unless they're really symptomatic.We have a fair number of pts with sickle cell trait who live around 9, so a fall to 7 postpartum/postop is not as big a jump as, say, 12 to 7, and they are able to compensate fairly well.Blood is not on my list of favorites either, as I seem to have the black cloud of transfusion reaction hanging over me.

Give blood almost every day worked, never a reaction though. We transfuse at the number the MD wants, not the blood bank. They do call and ask for a reason why and they are not happy, but they do send the blood. Last week a pt was transfused at a 9.4

In every job I've had, we usually didn't transfuse till 7, and sometimes less than that.

At my hospital we usually don't transfuse unless it's <7. This has been the common practice at my hospitalfor several years because of the increased M&M. But we will transfuse if the patient is symptomatic and not yet below 7. You have to also treat the patient, not just numbers.

For our ortho and gen surg pts there is normally a protocal to transfuse during the first couple days post-op if the Hematocrit drops to less than 25.