lays in obtaining laboratory results and blood for transfusion in emergency situations, blood shortages, and complications of transfusion (e.g., infectious disease and clerical errors).
A large percentage of allogeneic blood is transfused in the OR. To improve perioperative blood administration practices, a better understanding of current transfusion practices and the perceived impediments to change is needed. The 2002 survey identified significant changes in transfusion practices since the original survey in 1981. 21
Although the responses presumably reflect individual anesthesiologists’ behaviors in the clinical situations presented, they may not correctly reflect institutional practices. For example, 6% replied that their hospital does not have a transfusion committee, and 12% did not know whether one exists. The Joint Commission on Accreditation of Healthcare Organizations does not strictly require hospitals to have a transfusion committee or equivalent, but the Joint Commission on Accreditation of Healthcare Organizations does require an ongoing meaningful review of transfusion. In most hospitals, the transfusion committee performs this function.
Approximately half of the respondents did not know whether an MSBOS was used at their hospital, 27% said none was in use, and 20% indicated one was used. The percentage of hospitals using an MSBOS is unknown but is likely to be greater than 20%. Perhaps the respondents were not familiar with the term MSBOS. 22–24
The use of a type and screen is an integral component of an MSBOS. A large number of respondents expressed displeasure with the manner in which type and screen procedures were apparently used in their institutions, citing delays in obtaining blood when only a type and screen had been performed. It would seem that the systems are not working as they should and that some anesthesiologists are unfamiliar with the safety of administering uncrossmatched blood to patients with a negative antibody screen. Better communication between anesthesia departments and transfusion services might resolve many of these apparent problems.
In view of the large percentage of transfusions administered perioperatively, it is of interest that 62% of the anesthesiologists surveyed indicated that they never or rarely administer 3 or more units of blood to the same patient in a typical workweek, and 37% do so only one to five times a week. However, because many anesthesiologists are not involved in cases with large blood loss such as massive trauma, cardiac surgery, and liver transplantation, 10,23–26
this is not a surprising finding. The demographic characteristics of the respondents are similar to those of the ASA membership, suggesting that the survey participants were a representative random sample.
Despite reports of trends of decreasing numbers of blood donations and increasing numbers of blood transfusions 1
and blood shortages in many areas throughout the United States that result in elective surgical procedure delays, 96% of respondents in 2002 indicated that it was never or rarely necessary to cancel elective surgery because of unavailability of blood. Nevertheless, many of the anesthesiologists surveyed indicated that blood shortages are a major concern. Several expressed a desire to have whole blood available for transfusion, and 13% indicated that they do administer allogeneic whole blood.
Erythrocyte transfusion practices have improved since the 1981 survey. Fewer anesthesiologists (9%) still require patients to have a hemoglobin concentration of at least 10 g/dl before elective procedures than in 1981 (65%). No data are available for 1981 regarding the performance of intraoperative hemoglobin determinations, but the current responses indicate that 55% of anesthesiologists routinely (> 85% of the time) and 34% of anesthesiologists sometimes (6–85% of the time) perform hemoglobin or hematocrit determinations before intraoperative erythrocyte administration. Of those who use a “transfusion trigger,” most (39%) transfuse when the hemoglobin is less than 8 g/dl. Six percent transfu