that they would transfuse when hemoglobin was less than 10 g/dl (or hematocrit < 30%), 39% indicated that they would transfuse when hemoglobin was less than 8 g/dl (or hematocrit < 24%), and 6% indicated that they would transfuse when hemoglobin was less than 6 g/dl (or hematocrit < 18%). Forty-six percent indicated “other,” with conditional responses being the rate of blood loss and anticipated continued blood loss, the medical condition and age of the patient, and the clinical picture and hemodynamic stability. Reasons cited for not determining the hemoglobin or hematocrit intraoperatively include the following: tests not available in the OR, laboratory too slow in returning results, and transfusion decisions not based on hemoglobin or hematocrit values.
The frequency of performing coagulation tests intraoperatively before transfusing platelets, FFP, or cryoprecipitate was reported as rarely (≤ 5% of the time) by 19%, sometimes (6–85% of the time) by 44%, and routinely (> 85% of the time) by 31%. The reasons for not performing the tests were as follows: tests not available in the OR; laboratory too slow; and long time required for blood components to be available, so they are ordered regardless of test results.
Usefulness of ASA Transfusion Education Materials
Seventy-three percent of the respondents were aware of the ASA brochure “Questions and Answers about Transfusion Practices.” The information in the brochure was rated as somewhat useful by 55% of those aware of the brochure and very useful by 34%. Seventy-two percent of the respondents were aware of the ASA Practice Guidelines for Blood Component Therapy. The information was rated as somewhat useful by 55% of those aware of the guidelines and very useful by 36%.
Written Comments about Blood Transfusion Practices
Survey participants were offered the opportunity to provide written comments on blood transfusion practices. The primary problems in transfusion medicine identified by the respondents were as follows: 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).
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 tra