Blood lost and blood transfused in coronary artery bypass graft operation as implications for blood transfusion and blood conservation strategies.
We have analyzed the relationship between blood lost and blood transfusions given to 498 consecutive patients undergoing primary elective coronary artery bypass graft operations at 18 institutions. Seventy-nine percent of blood and 59 percent of patients were transfused only on the day of the operation. Patients who received none, 1 or 2 units of blood were not different when analyzed for blood transfusion risk factors except for the percentage of patients who were female. We identified 91 patients who received transfusion inappropriately, using a clinical indicator that analyzed blood losses for each patient. Forty-nine percent of all patients transfused could have avoided exposure to homologous blood if the equivalent of 4 units of the blood in erythrocyte volume had been provided for blood transfusion needs; if blood determined to have been transfused inappropriately had not been given, 95 percent of all patients would have received four or fewer erythrocyte units. We conclude that physician education and quality assurance programs need to be coupled with innovative blood conservation efforts that provide the equivalent of 4 units of homologous blood to minimize blood transfusions in this setting.
Goodnough
L T
LT
Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, Ohio.
Soegiarso
R W
RW
Geha
A S
AS
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D004911:Erythrocyte Volume; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors