Abstract
For years we were taught that the standard red blood cell (RBC) transfusion dose was 2 units; in fact, single-unit transfusions were strongly discouraged. Now with numerous randomized trials advocating restrictive transfusion strategies, single-unit blood transfusions are becoming the standard practice in hemodynamically stable nonbleeding patients. In 2014 the AABB released its Choosing Wisely "Five Things Physicians and Patients Should Question,"(1) including the recommendation "Don't transfuse more units of blood than absolutely necessary," which recommends single-unit RBC transfusions in stable patients. As part of our health system-wide blood management program, we started a "Why give 2 when 1 will do?" campaign in January 2015. A widespread communications effort followed (see figure, A) in hospital newsletters and on computer screensavers. At our three hospitals with the highest rate of double-unit transfusion orders, we witnessed an overall decrease (from 68% to 31%; see figure, B) in the percentage of 2-unit orders. Although many blood management programs are focused on the hemoglobin (Hb) concentration before transfusion (the Hb trigger), there is perhaps greater opportunity to reduce transfusion overuse by monitoring the "dose" of blood and encouraging single-unit transfusions. By doing so we can encourage an evidence-based "Hb target" 2 defined as the Hb level upon hospital discharge. Over the period described, the percentage of patients with a Hb target of more than 9 g/dL receiving transfusion decreased from 65% to 45%, and overall RBC utilization decreased by 18.2%.
