ed 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 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), de