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Reduction of blood use in surgery for coronary artery disease
Ninety consecutive patients underwent surgery for coronary artery disease. Eighty-one (90%) did not require blood transfusion in the immediate postoperative period; nine patients received 16 units of blood, 6 of whom bled excessively; 2 were re-explored. Twelve had post-operative haemoglobins below 8.5 G/dl during their stay. They were transfused a total of 28 units of blood before discharge. Post-operative blood loss in the 9 transfused early averaged 894 +/- 176 ml (SEM). Loss from the not transfused patients averaged 481 +/- 18 ml (p less than 0.001). Patients transfused later had a mean loss of 510 +/- 36 ml (P NS). Sixty-nine patients were not transfused. Haemoglobin on the first post-operative day was 11.3 +/- 1.3 G/dl (SD). This declined to 10.2 +/- 1.2 G/dl on the fifth day. Discharge haemoglobin was 10.5 +/- 1.2 G/dl. Two patients died, one of myocardial infarction on the third day and the other of pancreatitis on the fourth. Both had had early blood transfusion. Haemoglobins were above 10 G/dl. Of the 69 untransfused patients 17% had supraventricular arrhythmias. Ten percent had serous wound discharges; 3 were infected. There were no sternal dehiscences. It is concluded that bank blood transfusion with its attendant hazards and expense is easily avoidable in most patients. This saving of resources will increase the availability of blood and rare groups for surgery.
Ninety consecutive patients underwent surgery for coronary artery disease. Eighty-one (90%) did not require blood transfusion in the immediate postoperative period; nine patients received 16 units of blood, 6 of whom bled excessively; 2 were re-explored. Twelve had post-operative haemoglobins below 8.5 G/dl during their stay. They were transfused a total of 28 units of blood before discharge. Post-operative blood loss in the 9 transfused early averaged 894 +/- 176 ml (SEM). Loss from the not transfused patients averaged 481 +/- 18 ml (p less than 0.001). Patients transfused later had a mean loss of 510 +/- 36 ml (P NS). Sixty-nine patients were not transfused. Haemoglobin on the first post-operative day was 11.3 +/- 1.3 G/dl (SD). This declined to 10.2 +/- 1.2 G/dl on the fifth day. Discharge haemoglobin was 10.5 +/- 1.2 G/dl. Two patients died, one of myocardial infarction on the third day and the other of pancreatitis on the fourth. Both had had early blood transfusion. Haemoglobins were above 10 G/dl. Of the 69 untransfused patients 17% had supraventricular arrhythmias. Ten percent had serous wound discharges; 3 were infected. There were no sternal dehiscences. It is concluded that bank blood transfusion with its attendant hazards and expense is easily avoidable in most patients. This saving of resources will increase the availability of blood and rare groups for surgery.