vey indicated that they used the same criteria for reinfusion of preoperatively donated autologous blood as for allogeneic blood, whereas 38% transfused autologous blood more liberally.
The reported practice of reconstituting or diluting erythrocytes with crystalloid (vast majority using normal saline) increased from 69% in the 1981 survey to 87% of respondents in the 2002 survey (P < 0.001). This practice was performed to decrease the viscosity of the erythrocyte units. The use of micropore filters for all erythrocyte transfusions increased from 37% in 1981 to 60% in 2002 (P < 0.001). Use of blood warmers for all erythrocyte transfusions increased from 48% in 1981 to 89% in 2002 (P < 0.001).
The primary indications for requesting that platelets be available were a platelet count below a specified value and surgical procedures usually associated with significant blood loss. In 1981, 80% replied that they requested platelets to be available in the first situation, specifying a mean platelet count of 68 × 109/l. In 2002, 89% of the respondents requested that platelets be available for patients with a mean platelet count of 74 × 109/l (P < 0.001) and significant anticipated blood loss. In 1981, 33% requested that platelets be available if more than one blood volume replacement was required; 56% responded similarly in 2002 (P < 0.001).
A question regarding platelet transfusion practices, which had response choices based on the ASA Guidelines, was added to the 2002 survey (question 10, Appendix 2
). Fifty-five percent of respondents would transfuse platelets prophylactically in a patient with idiopathic thrombocytopenic purpura and a platelet count of 20 × 109
/l, although the ASA Guidelines state that prophylactic platelet transfusion is ineffective and rarely indicated in patients with idiopathic thrombocytopenic purpura. Platelets would have been transfused by 51% of anesthesiologists in 2002 to patients with microvascular bleeding and platelet counts less than 100 × 109
/l. Thirty-three percent would have transfused platelets to patients in whom one blood volume had been replaced. Only 12% would administer platelets prophylactically to patients with platelet counts between 50 and 100 × 109
The 2002 survey had two questions related to fresh frozen plasma (FFP) administration (questions 11 and 12, Appendix 2
). For question 11, the two most frequent responses were consistent with the ASA Guidelines: 83% administered FFP for urgent reversal of warfarin therapy, and 72% transfused patients with microvascular bleeding and prothrombin and activated partial thromboplastin times of 1.5 times normal. Only 6% of the respondents would transfuse patients with these laboratory values in the absence of clinical bleeding. When blood replacement exceeds 50–100% of estimated blood volume, 47% would transfuse FFP; 9% would transfuse FFP when blood replacement exceeds 25–50% of estimated blood volume. Forty-eight percent would administer FFP only on the basis of abnormal clotting studies. “None of the above” was chosen by 2%, and “other” was chosen by 6%.
When treating adult patients, 61% administered 2 U of FFP and checked prothrombin time and/or activated partial thromboplastin time; 16% transfused the same amount of FFP, but did not check the prothrombin time or activated partial thromboplastin time. Only 8% administered 10–15 ml/kg of FFP, which is the dose suggested in the ASA Guidelines. Seventy-eight percent would administer cryoprecipitate to a bleeding, massively transfused patient with a fibrinogen concentration less than 100 mg/dl, and 67% would administer cryoprecipitate to a patient with von Willebrand disease who was bleeding.
Use of Laboratory Testing in the OR
In 2002, hemoglobin or hematocrit was determined routinely (> 85% of the time) before transfusing erythrocytes in the OR by 55% of respondents, sometimes (6–85% of the time) by 34% of respondents, rarely (≤ 5% of the time) by 8% of respondents, and never by 3% of respondents. Of those who responded to the above question with routinely, sometimes or rarely 6% indicated 