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Don’t transfuse plasma to correct a mildly elevated (<1.8) international normalized ratio (INR) or activated partial thromboplastin time (aPTT) before a procedure
Choosing Wisely Canada
Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto
A mildly elevated INR is not predictive of an increased risk of bleeding. Furthermore, transfusion of plasma has not been demonstrated to significantly change the INR value when the INR was only minimally elevated (<1.8).
ver más ... 2014Don’t transfuse more than one Red cell unit at a time when transfusion is required in stable, non-bleeding patients
Choosing Wisely Canada
Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto
Indications for red blood transfusion depend on clinical assessment and the cause of the anemia. In a stable, non-bleeding patient, often a single unit of blood is adequate to relieve patient symptoms or to raise the hemoglobin to an acceptable level. Transfusions are associated with increased morbidity and mortality in high-risk hospitalized inpatients. Transfusion decisions should be influenced by symptoms and hemoglobin concentration. Single unit red cell transfusions should be the standard ...
ver más ... 2014Don’t transfuse blood if other non-transfusion therapies or observation would be just as effective
Choosing Wisely Canada
Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto
Blood transfusion should not be given if other safer non-transfusion alternatives are available. For example, patients with iron deficiency without hemodynamic instability should be given iron therapy.
ver más ... 2014Don’t send urine specimens for culture on asymptomatic patients including the elderly, diabetics, or as a follow up to confirm effective treatment
Choosing Wisely Canada
Canadian Association of Pathologists - Canadian Medical Association - University of Toronto
There is no evidence that antibiotic treatment is indicated in any of these patients. Thus sending urine specimens in asymptomatic patients will only result in inappropriate antibiotic use and increased risk of resistance. The only exceptions are screening of pregnant women early in pregnancy for whom there are clear guidelines for screening/management; and screening for asymptomatic bacteriuria before urologic procedures for which mucosal bleeding is anticipated.
ver más ... 2014Avoid standing orders for repeat complete blood count (CBC) on inpatients who are clinically/laboratorily stable
Choosing Wisely Canada
Canadian Association of Pathologists - Canadian Medical Association - University of Toronto
Standing orders for inpatients for CBC testing should be avoided as this can lead to over-testing in relatively stable patients. Particularly in patients with longer term hospital stays, there is some evidence that repeated blood testing can have a negative effect on patients including some increase in anemia. Trauma patients often have blood draws repeated frequently even in the absence of indications of hematologic instability on admission.
ver más ... 2014