Percentage of adult patients receiving a blood transfusion with documented hemoglobin or hematocrit value prior to administration. 

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.

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

Adult patients requiring anesthesia who receive a transfusion.

• Age < 18 years
• ASA 5 & 6 including Organ Procurement (CPT: 01990)
• Cesarean Delivery Cases (determined by Obstetric Anesthesia Type value codes: 1, 2, 4, 7, 8) with an EBL > 1500cc or the HR>110, SBP<85, DBP<45, or O2Sat <95%
• Massive Blood loss with EBL > 2000 mL
• Massive Transfusion of 4 or more units of blood from 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
• No intraoperative transfusion
• Postpartum hemorrhage cases (ICD-10 code: 072.0, 072.1, 072.2, 072.3)
• Procedures:
  • Burn cases (CPT codes 01951, 01952, 01953)
  • Labor epidurals (determined by the ‘Obstetric Anesthesia Type’ value codes: 3 & 6 including obstetric non-operative procedures – CPT: 01958)

Documentation of hemoglobin and/or hematocrit within 90 minutes prior to blood transfusion

• 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 ≤ 7/21, 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
• For Cardiac Cases (determined by Procedure Type: Cardiac value codes >0) Only: 
  • Autologous units (ID: 10489) are not considered. If autologous units are given in addition to other PRBC units, hemoglobin or hematocrit to be assessed before all non-autologous transfusions.
  • If only autologous units are administered, the case will be excluded.
• Hemoglobin values reported in g/L are divided by 10 to convert to g/dL.
• Hematocrit values < 1 reported in L/L (liters of blood cells per liter of blood volume) are multiplied by 100

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Not applicable

Provider(s) who administered blood product

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.