Transfusion practice in orthopedic patients: do we really need it?

To determine the proportion of inappropriate transfusions in patients undergoing orthopaedic surgery at a tertiary care university hospital, and factors associated with inappropriate transfusions.

The prospective study was conducted at Aga Khan University Hospital, Karachi, from December 2008 to September 2009, and comprised patients admitted to the Orthopaedic Department and received transfusion of at least one packed cell. Patients were divided into four groups: A, those with haemoglobin < 7, B, haemoglobin 7.1-10 without ischemic heart disease, C, haemoglobin 7.1-10 with ischemic heart disease, and D, haemoglobin >10. Variables recorded were, pre-transfusion haemoglobin level, co-morbids, symptoms of hypovolemia, pre-transfusion volume replacement with fluids, transfusion reactions, and haemoglobin after 48 hours. Indications of transfusion were assessed in accordance with available data.

Of the 126 patients, 65(52%) were males and 61(48%) were females. There were 18(14%) patients in group A, 88(70%) in group B, 12(10%) in group C, and 8(6%) in group D. Overall, Overall, 44(35%) were transfused appropriately according to the criteria, and 82(65%) were inappropriate.

The number of inappropriate transfusion was quiet high and demands revision of institutional policy of packed cell transfusion in accordance with available guidelines.