nsfusion 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 transfuse when the hemoglobin concentration is less 10 g/dl, and 6% do not administer erythrocytes until the hemoglobin concentration is less than 6 g/dl. A greater number (52%) rely on changes in vital signs (i.e.
, decreased blood pressure, significant increases in pulse rate) when transfusing erythrocytes than in 1981 (15%). The use of lower transfusion triggers combined with clinical evaluation is consistent with the ASA Guidelines, as well as the recommendations of other organizations. 18,27,28
Coagulation testing is performed routinely (> 85% of the time) by 31% or sometimes (6–85% of the time) by 44% of anesthesiologists before administration of platelets, FFP, or cryoprecipitate in the OR. The responses indicate that transfusion of these components is generally consistent with the ASA Guidelines. Exceptions are the prophylactic administration of platelets to patients with idiopathic thrombocytopenic purpura and infusion of volumes of FFP different from those recommended in the ASA Guidelines. Many respondents cited the lack of readily available coagulation testing in the OR as a problem. Although combining coagulation test results with clinical evaluation is optimal, a limitation to the widespread use of point-of-care coagulation testing is infrequent use. In addition, many of these tests have a different normal range than the hospital laboratory tests do, potentially confusing interpretation of test results. Few of the responding anesthesiologists transfused large volumes of blood on a regular basis. Thus, point-of-care coagulation testing might rarely be used, bringing its cost effectiveness into question.
Autologous transfusion practices have changed. In 1981, only 49% of respondents indicated that a mechanism was established in their hospitals for patients to predonate blood for elective surgery. The same question was not repeated on the 2002 survey, but it is assumed that predonation is more widely available as a result of current requirements that patients undergoing elective surgery be offered alternative