http://bmj.com/cgi/content/full/325/7364/564/a
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 Collections under
which this article appears: Orthopaedic
and Trauma Surgery Haematology
Incl Blood Transfusion |
Roger Dobson Abergavenny
A hospital that introduced a stringent transfusion policy has substantially reduced the amount of blood it uses.
The proportion of patients undergoing coronary artery bypass graft who received a transfusion fell from 57% to 45% and of patients undergoing hip replacement from 52% to 26%, with no increase in length of stay in hospital, according to a report of an audit of the use of blood after the introduction of the policy at the South Manchester University Hospital (J R Soc Med 2002;95:450-2).
The new policy for red blood cell transfusion, brought in at the end of 1999, included a standard blood ordering schedule and a transfusion trigger of a haemoglobin concentration of <8 g/dl in the absence of symptoms.
To investigate the impact of the trigger on practice, researchers audited transfusion requirements in surgery for six months before and after the guidelines were brought in.
They audited four elective surgical procedures associated with substantial transfusion requirements—400 coronary artery bypass grafts, 107 total hip replacements, 85 colectomies, and 159 transurethral prostatectomies.
"This study showed a reduction in red-cell transfusions after introduction of a transfusion policy. This reduction was evident in cardiac surgery and was particularly impressive in orthopaedic surgery, with transfusions halved and haemoglobin concentrations at discharge substantially lower. Inpatient stay was not increased by the more stringent transfusion policy—indeed, in the [coronary artery bypass graft] and hip replacement groups it declined," says the report.
Although transfusion practice for colectomy did not seem to change after introduction of the transfusion trigger, haemoglobin concentrations at discharge were lower after the introduction of the policy—suggesting, says the report, that surgeons were more willing to withhold transfusion.
"Blood is often given inappropriately with consequent risks for patients and wastage of limited and expensive resources. There are several reasons why a reduction in homologous blood use is desirable. Aside from the obvious avoidance of complications, withholding unnecessary transfusions may spare patients the immunomodulatory effect of homologous blood, which is suspected by some of increasing susceptibility to bacterial infection or cancer recurrence. There is also growing concern about future availability of blood stocks in view of the impending routine testing of all homologous blood products for the agent of variant Creutzfeldt-Jakob disease," says the report.
It adds: "Although other factors cannot be excluded, we suggest that the
reductions in red-cell transfusion were in large part attributable to the new
transfusion policy."
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Collections under
which this article appears:Orthopaedic
and Trauma Surgery Haematology
Incl Blood Transfusion |
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