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Transfusion thresholds in common elective surgical procedures in Finland.
L Capraro1, L Nuutinen, G Myllylä
1Finnish Red Cross Blood Transfusion Service, Helsinki, Finland. leena.capraro@bts.redcross.fi
Vox Sanguinis
|April 15, 2000
Summary
This study found liberal red blood cell (RBC) transfusion practices in Finnish hospitals for common surgeries like total hip replacement (THR) and total knee replacement (TKR). High transfusion rates indicate a need for updated transfusion policies and education.
Area of Science:
- Anesthesiology
- Transfusion Medicine
- Health Services Research
Background:
- Investigated transfusion practices and thresholds in elective surgeries nationwide in Finland.
- Focused on total hip replacement (THR), total knee replacement (TKR), and transurethral resection of the prostate (TURP).
Purpose of the Study:
- To assess current transfusion practices and thresholds in common elective surgical procedures.
- To compare Finnish transfusion practices with international recommendations.
Main Methods:
- Nationwide multicenter survey.
- Retrospective review of 764 THR, 397 TKR, and 343 TURP patient records.
- Analysis by four anesthesiologists.
Main Results:
- Allogeneic red blood cell (RBC) transfusion rates were 92% for THR, 84% for TKR, and 18% for TURP.
- 74% of THR and TKR patients with ≤20% blood loss received RBC transfusions.
- Median pretransfusion hemoglobin was 9.6 g/dl (orthopedics) and 10.7 g/dl (TURP); some TURP thresholds reached 11.2 g/dl.
Conclusions:
- Transfusion thresholds in Finland were liberal compared to international guidelines.
- High transfusion rates are linked to inappropriate thresholds.
- Emphasized the need for ongoing discussion and education to optimize transfusion indications and rationalize policies.