Box 1.

Definition of possible unnecessary transfusion above pre-transfusion haemoglobin (Hb) trigger.

The categories below are stepped in that anaemia patients at one level are those remaining after patients belonging to all earlierlevels have been excluded. For example, level 2 patients with thalassaemia are selected from the whole group of anaemia patients after excluding the level 1 patients with radiotherapy.
  1. Radiotherapy and pre-Hb >110 g/L

  2. Thalassaemia and pre-Hb >100 g/L Age >65 with bone marrow failureA and pre-Hb >90 g/L

  3. Age >65 with chemotherapy and pre-Hb >90 g/L

  4. Age >65 without bone marrow failureA or chemotherapy or comorbidityB and pre-Hb >80 g/L

  5. Any age with comorbidityB and pre-Hb >80 g/L

  6. Age ≤65 with bone marrow failureA and pre-Hb >80 g/L

  7. Age ≤65 with chemotherapy and pre-Hb >80 g/L

  8. Age ≤65 without bone marrow failureAor chemotherapy or comorbidityB and pre-Hb >70 g/L

  • AAplastic anaemia, Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Myelodysplasia, Myeloproliferative disease (myelofibrosis), Chronic leukaemia any type, Myeloma, Non-haematological malignant infiltration (Q6B1 thru Q6B9)

  • BCardiac, respiratory or vascular disease (Q13) or on any of the drugs (Q13b)

  • In patients with acute blood loss, a threshold of 100 g/L has been set

  • Reproduced with permission from the National Comparative Audit of Blood Transfusion.2