Measure ID

Percentage of patients with a blood transfusion that have a hemoglobin or hematocrit value documented prior to transfusion. 

Measure Type

The American Association of Blood Banks (AABB) recommends a transfusion threshold of hemoglobin concentration less than or equal to 8 g/dL or when patient is symptomatic (chest pain, orthostatic hypotension, tachcardia unresponsive to fluid resuscitation, or congestive heart failure).1,2 Furthermore, blood transfusions in non-cardiac surgery have been associated with increased risk of 30-day mortality and morbidity.3

Although the literature is not conclusive on the exact hemoglobin concentration that requires transfusion, the evidence is clear that use of fewer RBC transfusions reduces cost and risk for adverse effects of transfusion, and that transfusion for hemoglobin values greater than 10 g/dL is usually not indicated.

TRAN 01 is a process measure focused on measuring hemoglobin or hematocrit prior to transfusion. The rationale for this measure is that the decision to transfuse should include knowledge of the hemoglobin value before administration of blood.  Because the literature is not absolutely conclusive on a specific hemoglobin threshold for transfusion, TRAN 01 does not include the actual hemoglobin value as part of the measure.

Measure Time Period

Up to 36 hours prior to the first transfusion during the case


All surgical patients receiving anesthetics who receive a transfusion of red blood cells.

  • ASA 5 & 6 including Organ Harvest (CPT: 01990)
  • Burn cases (CPT Codes 01951, 01952, 01953)
  • Cardiac Procedures
  • Exclude patients with an EBL > 1500cc during cesarean section as determined by MPOG ‘Obstetric Anesthesia Type’ phenotype results:
    • ‘Cesarean Delivery’
    • ‘Cesarean Hysterectomy’
    • ‘Conversion (Cesarean Delivery portion)’
    • ‘Conversion (Cesarean Hysterectomy portion)’
    • 'Conversion (Labor Epidural and Cesarean Delivery Combined)'
  • Exclude patients with a HR>110, SBP<85, DBP<45, or O2Sat <95% during cesarean section as determined by MPOG ‘Obstetric Anesthesia Type’ phenotype results:
    • ‘Cesarean Delivery’
    • ‘Cesarean Hysterectomy’
    • ‘Conversion (Cesarean Delivery portion)’
    • ‘Conversion (Cesarean Hysterectomy portion)’
    • 'Conversion (Labor Epidural and Cesarean Delivery Combined)'
  • Exclude postpartum hemorrhage cases (ICD-10 code: O72.0, O72.1, O72.2, O72.3)
  • Labor Epidurals as determined by the MPOG 'Obsteric Anesthesia Type' phenotype results 'Labor Epidural' and 'Conversion (Labor Epidural Portion)'
  • Massive Blood loss: EBL ≥ 2000 ml
  • Massive Transfusion: Transfusion of 4 or more units of blood; 4 hours before Anesthesia Start to Anesthesia End.
    • Note for sites that document transfusions in ml instead of units: ASPIRE will default to 300ml/unit.
  • Obstetric Non-Operative Procedures - CPT 01958
  • Patient age < 18 years

*Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'

Success Criteria
  • Documentation of hemoglobin and/or hematocrit within 90 minutes prior to blood transfusion
Other Measure Details
  • Considerations:
    • For the first unit of transfusion, a hemoglobin or hematocrit of any value should be checked in a time period of 0 to 90 minutes before the transfusion, or the most recent documented hemoglobin or hematocrit of less than 8/24 should be within 36 hours of the transfusion.
    • If the last hemoglobin or hematocrit drawn before the first transfusion is ≤ 5/16, a second unit could be administered without rechecking hemoglobin/hematocrit.
    • If multiple units are administered, documentation of a hemoglobin or hematocrit value must be present within 90 minutes before each administration.
  • Transfusion is defined as:
    • Packed Red Blood Cells-Autologous, Homologous, Unknown Type
    • Whole Blood-Homologous, Unknown Type                          
    • Categorized Note- Blood Products
  • Hematocrit/hemoglobin are defined as:
    • POC - Blood gas-Hct measured,  Hemoglobin
    • POC – Hematocrit spun
    • POC – Coulter counter – Hematocrit, Hemoglobin
    • Formal lab – Hematocrit,  Hemoglobin
    • Formal lab - Blood gas - Hct measured, Hemoglobin
Risk Adjustment

Not applicable

Provider Attribution

Provider(s) who administered blood product

MPOG Concept Used

Blood Products

  • 10489   Packed Red Blood Cells- Autologous
  • 10490   Packed Red Blood Cells- Homologous
  • 10492   Whole Blood- Homologous
  • 10616   Packed Red Blood Cells- Unknown Type
  • 10617   Whole Blood- Unknown Type
  • 10618   Categorized Note- Blood Products
  • 10499   EBL

Point of Care Testing 

  • 3415     POC-Blood gas-Hct measured
  • 3435     POC- hematocrit spun
  • 3440     POC- Coulter counter- Hemoglobin
  • 3450     POC- Coulter counter- Hematocrit
  • 5081     POC- Blood gas- Hemoglobin

Formal Labs

  • 5005     Formal lab- Hemoglobin
  • 5006     Formal lab- Hematocrit
  • 5038     Formal lab- Blood gas- Hct measured
  • 5080     Formal lab- Blood gas- Hemoglobin



1. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Annals of internal medicine. 2012;157(1):49-58.

2. Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. Jama. 2016;316(19):2025-2035.

3. Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114(2):283-292.

Measure Authors

 Measure Author


 Nirav Shah, MD

 University of Michigan

 Kate Buehler, MS, RN

 University of Michigan

 Jaime Osborne, RN

 University of Michigan

 Jay Jeong

 University of Michigan

 Sachin Kheterpal, MD

 University of Michigan

 MPOG Quality Committee



Measure Reviewer(s)
Next Review: 2024
 Date Reviewed  Reviewer  Institution  Summary  QC Vote


 Linda Lui, MD

 Masakatsu Nanamori, MD


 HFHS - Detroit



Published Date: 09/2015
 Date  Criteria  Revision