Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study

Olivier Peyrony (1) , Danaé Gamelon (2) , Romain Brune (1) , Anthony Chauvin (3) , Daniel Aiham Ghazali (4) , Youri Yordanov (5) , Aude Arsicaud (6) , Pauline Gilleron (7) , Sonja Curac (8) , Marie-Caroline Richard (9) , Anne-Laure Feral-Pierssens (10) , Barbara Villoing (11) , Sébastien Beaune (12) , Hélène Goulet (2) , Jean-Paul Fontaine (1) , Anne François (13) , France Pirenne (1)

1 AP-HP - Hopital Saint-Louis [AP-HP]
2 CHU Tenon [AP-HP]
3 Hôpital Lariboisière-Fernand-Widal [APHP]
4 CIC - CHU Bichat
5 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
6 CHV - Centre Hospitalier de Versailles André Mignot
7 ICPAL - Institut de Chimie Pharmaceutique Albert Lespagnol
8 Hôpital Beaujon [AP-HP]
9 CHU Pitié-Salpêtrière [AP-HP]
10 HEGP - Hôpital Européen Georges Pompidou [APHP]
11 Hôpital Cochin [AP-HP]
12 Hôpital Ambroise Paré [AP-HP]
13 EFS - Etablissement Français du Sang [La Plaine Saint-Denis]

Background: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. Methods: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. Results: During the study period, 529 patients received RBC transfusion. The median age was 74 (59–85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0–7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29–3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53–3.94), and older age (OR: 1.02/year; 95% CI: 1.01–1.04). Conclusion: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.

Mots clés: transfusion; red blood cell; blood product; anemia; hemoglobin; emergency department

Domaines: Hématologie

Olivier Peyrony, Danaé Gamelon, Romain Brune, Anthony Chauvin, Daniel Aiham Ghazali, et al.. Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study. Journal of Clinical Medicine, 2021, 10 (11), pp.2475. ⟨10.3390/jcm10112475⟩. ⟨hal-03266527⟩