s to allogeneic transfusion. When predonated autologous blood is available, 61% use the same criteria for transfusion as for allogeneic blood, whereas 39% administer autologous blood more liberally. Although controversial, the ASA Guidelines support the latter practice. Ninety-five percent of respondents indicated that equipment is currently available for intraoperative autologous transfusion, whereas only 38% had such equipment for intraoperative blood salvage and reinfusion in 1981. The frequency of use of acute normovolemic hemodilution is unknown. However, the percentage of respondents indicating that they had used acute normovolemic hemodilution was 22% in 1981, and 31% of respondents to the 2002 survey indicated that they had used the technique within the previous 12 months.
There are multiple possible limitations to our study. Surveys measure people's perceptions and not necessarily reality. Respondents also may give responses that they consider correct or expected rather than indicating their actual practices. Because this survey was sponsored by the ASA, it is possible that respondents may have given answers consistent with ASA publications, rather than their actual behavior. It is of interest that the necessity to cancel elective surgery because of nonavailability of blood has decreased since 1981, although many of the anesthesiologists surveyed indicated that blood shortages were a major concern. As with all surveys, the data derived are only as good as the survey instrument and the sampling of the population. Our survey instrument was a modification of a previous survey to allow comparisons with the previous survey, and every effort was made to make it a valid survey tool. A randomization process was used to obtain a random sample of active ASA members. There is bias in our study population because only active members of the ASA were surveyed and a large percentage of academic anesthesiologists responded. Finally, the results of the survey only reflect the impressions of those who returned the survey, which was 41%. This response rate is similar to other national surveys of medical professional organization members. 29,30
We have no means of identifying and eliciting the responses of the anesthesiologists who chose not to respond to the survey.
In summary, significant changes in transfusion practices among anesthesiologists have occurred since 1981. Several organizations, including the ASA, promulgated transfusion guidelines during that time. Most anesthesiologists (72%) are familiar with the ASA Guidelines. Of those who are familiar with the guidelines, 55% find them somewhat useful, and 36% find them very useful. It would seem from the responses to the questions about platelet, FFP, and cryoprecipitate administration that the ASA Guidelines are, in general, being followed. The majority of anesthesiologists also seem to transfuse allogeneic and autologous erythrocytes in a manner consistent with the ASA Guidelines. The primary problems in transfusion medicine identified by the respondents were overtransfusion (particularly by surgeons), delays in obtaining laboratory results and blood for transfusion in emergency situations, blood shortages, and complications of transfusion (e.g., infectious disease and clerical errors). Several issues (e.g., platelet administration to patients with idiopathic thrombocytopenic purpura and preoperative blood ordering procedures) were identified that warrant further educational endeavors and improved interaction with local transfusion services.
Appendix 1: 2002 American Society of Anesthesiologists Committee on Transfusion Medicine
Appendix 2: Survey of Active ASA Members Conducted in 2002 by the ASA Committee on Transfusion Medicine
1. National Blood Data Resource Center: Blood collections continue to decline, American Association of Blood Banks. Bethesda, 1999, pp 9
2. Goodnough LT, Johnston MF, Toy PT: The variability of transfusion practice in coronary artery bypass surgery. JAMA 1991; 265: 86–90
3. Wallace EL, Surgenor DM, Hao HS, An J, Chapman RH, Churchill WH: Collectio