Paradigm shift in transfusion practices during early COVID-19 pandemic: A single center retrospective study

Table 1 Restrictive transfusion guidelines from Association for the Advancement of Blood and Biotherapies published in 2016

Transfusion threshold	Patient population
Hemoglobin ≤ 7 g/dL	Hospitalized adult patients who are hemodynamically stable, including critically ill patients
Hemoglobin ≤ 8 g/dL	Patients undergoing orthopedic surgery, cardiac surgery, and those with preexisting cardiovascular disease

These recommendations do not apply to patients with acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk of bleeding), and chronic transfusion dependent anemia.

Table 2 Restrictive red blood cells transfusion criteria as per institutional guidelines

RBC transfusion threshold	Patient population
Hemoglobin ≤ 7 g/dL	Hemodynamically stable patients on medical floors and ICU
Hemoglobin ≤ 8 g/dL	Hemodynamically stable patients on medical floors and ICU with preexisting CVD1
Hemoglobin ≤ 10 g/dL	Active bleed2
Hemoglobin ≤ 10 g/dL	Down-trending hemoglobin3

¹Pre-existing cardiovascular disease is defined as past history of at least one episode of angina irrespective of percutaneous coronary intervention.

²Active bleed is defined as documented witnessed bleed by nurse/physician or hemodynamic instability attributed to bleeding.

³Down-trending hemoglobin is defined as fall in hemoglobin more than or equal to 2 g/dL.

CVD: Cardiovascular disease; ICU: Intensive care unit.

Table 3 Demographic and clinical characteristics, n (%)

Variable	COVID era (n = 108)	Pre COVID era (n = 100)	P value
Demographics
Mean age, years	68	70	0.295
Sex
Male	51 (47.2)	49 (49)	0.798
Female	57 (52.8)	51 (51)	0.798
Race1
Caucasian	86 (79.6)	84 (84)	0.758
Hispanics	1 (0.9)	1 (1)	0.758
African American	8 (7.4)	3 (3)	0.758
Asian	2 (1.9)	2 (2)	0.758
Others	11 (10.2)	10 (10)	0.758
Clinical characteristics
Preexisting CVD	15 (13.9)	29 (29)	0.008
Prior GIB	11 (10.2)	8 (8)	0.585
Active antiplatelet/anticoagulant use	20 (18.5)	46 (46)	0.001
Inpatient VTE prophylaxis2	15 (13.9)	29 (29)	0.001
RBC transfusions in ICU	42 (38.9)	22 (22)	0.008

¹Race was determined by the participants.

²Unfractionated or low molecular weight heparin.

CVD: Cardiovascular disease; ICU: Intensive care unit; VTE: Venous thromboembolism; GIB: Gastrointestinal bleeding; COVID: Coronavirus disease.

Table 4 Comparison of number of red blood cells transfusions meeting restrictive transfusion criteria in the coronavirus disease and pre-coronavirus disease era, n (%)

Restrictive transfusion criteria met	Number and percentage of red blood cell transfusions
	COVID era	Pre-COVID era
Yes	67 (62)	79 (79)
No	41 (38)	21 (29)
P value	0.008

COVID: Coronavirus disease.