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Equilibration of Hemoglobin Concentration after Transfusion in Medical Inpatients Not Actively Bleeding
- Andrew R. Wiesen, MD;
- Duane R. Hospenthal, MD, PhD;
- John C. Byrd, MD;
- Kevin L. Glass, MD;
- Robin S. Howard, MA; and
- Louis F. Diehl, MD
- From the Walter Reed Army Medical Center, Washington, D.C. Requests for Reprints: Andrew R. Wiesen, MD, Internal Medicine Clinic, Lister Army Community Hospital, Ft. Rucker, AL 36362.
More than 12 million units of packed erythrocytes are transfused annually [1, 2]. Because blood products became widely used after World War II, hundreds of millions of units have been given [1-4]. Major textbooks state that an increase of 10 g/L (1 g/dL) of hemoglobin is expected per unit of blood transfused [5-10]. Authors [5, 8, 11] have implied that after transfusion, the rate at which the hemoglobin concentration equilibrates takes about 24 hours, but the supporting evidence is scant. The ability to rapidly determine the increase in hemoglobin levels after transfusion is important in managing outpatients and acutely ill patients. A standard time to measure the hemoglobin levels would save unnecessary blood draws.
To clarify these issues, we did a prospective study of medical inpatients at a tertiary care medical center to determine the amount of increase in hemoglobin levels after transfusion and the rapidity of equilibration. Hemoglobin levels rather than hematocrit levels were chosen because they are directly measured, not calculated [12].
Methods
Participants
Patients on the general medicine service of a 700-bed teaching hospital from January to June 1993 were eligible if they were to receive a 2-unit packed erythrocyte transfusion. Exclusion criteria included age younger than 18 years, recent active bleeding, and inability to give a written informed consent. Hemoglobin concentration was measured at 15 minutes, 1 hour, 2 hours, and 24 hours after the end …
