An analysis of transfusion practice and the role of intraoperative red blood cell salvage during cesarean delivery.
BACKGROUND
We sought to determine to what extent intraoperative salvaged red blood cells (RBC) might theoretically reduce exposure to appropriately transfused allogenic erythrocytes in Cesarean delivery patients.


METHODS
Medical records of Cesarean delivery patients requiring blood transfusions from January 1, 1992 to June 30, 1996 and June 1, 1998 to June 30, 2003 were reviewed. For each patient, we calculated the number of allogenic RBC units that could have theoretically been avoided had intraoperative autotransfusion been performed, based upon estimated blood loss, preoperative hematocrit, and the amount of retrieved blood needed to yield a single RBC unit. RBC transfusion appropriateness was determined using the recommended guideline of transfusing RBCs if the hemoglobin is <7 gm/dL in a patient with continuing bleeding.


RESULTS
A small percentage of Cesarean delivery patients (1.8%) received blood product transfusions. Of 207 patients receiving blood transfusions, salvaged erythrocytes could have theoretically decreased exposure to allogenic RBCs in 115 (55.6%) patients. Only 75.7% of these 115 patients were appropriately transfused with erythrocytes.


CONCLUSIONS
Theoretically, based on best, average, and worst RBC salvage recovery calculations, 25.1%, 21.2%, or 14.5% of the appropriately transfused patients, respectively, could have completely avoided allogenic RBC transfusion.
Fong
Jill
J
Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10021, USA. JIF2001@med.cornell.edu
Gurewitsch
Edith D
ED
Kang
Hey-Joo
HJ
Kump
Lisa
L
Mack
Patricia Fogarty
PF
D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002585:Cesarean Section / Q000379:methods*; D004909:Erythrocyte Indices; D017707:Erythrocyte Transfusion / Q000379:methods*; D004912:Erythrocytes / Q000166:cytology*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy
D006454:Hemoglobins