Effect of Urgent Clinician Notification of Low Hemoglobin Values (Evidence-Based Laboratory Medicine and Test Utilization‪)‬

Red blood cell transfusions generally are recommended in hospitalized patients if the hemoglobin is 60 g/L (1, 2). Delay in appropriate use of red cell transfusion might put the patient at risk for hypoxic complications. Although the risk of acute events attributable to anemia probably occurs only with a hemoglobin concentration 50 g/L (2, 3), patients with ischemic heart disease might be at risk with higher values. Because the clinical signs of anemia are unreliable (4, 5), contacting the physician immediately when the blood count is unexpectedly low could be prudent. Immediate physician notification of a low hemoglobin obtained during an office visit, however, might lead to adverse consequences. Inappropriate notification squanders human resources and penalizes the physician with an untimely information overload (6, 7). A telephone call, in itself, might suggest the need for immediate attention, leading to unwarranted referrals to the emergency room (ER), inconvenience and anxiety for patient and family, and even unnecessary blood transfusions (2, 8). We are unaware of any outcome studies that demonstrate either the benefits or risks of this practice. Materials and Methods