BLOOD AND COAGULATION PRODUCT DISPOSAL IN THE MODERN ERA - A SURVEY AND REVIEW OF CURRENT PRACTICE

Abstract

Introduction Perioperative transfusion is associated with reduced with reduced survival1 and increased morbidity and mortality2 Several studies report poor adoption of guidelines and wide variation in clinical practice3. However, the influence of simple practical factors is disregarded, as for instance which blood products are available in which time for the transfusing physician? We hypothesize that local practical issues are a relevant cofounder of transfusion decisions. Methods With kind endorsement of EACTAIC, the link to a web-based survey was sent via newsletter to all EACTAIC-Members via the monthly newsletter in November 2020. Results The Newsletter was opened by 429 active members. We collected 66 survey responses, with 51 complete surveys, resulting in a response rate of 11.9% 72% of participants report having a local algorithm for the use of blood products and coagulation factors. Several factors were reported as having an influence on the local transfusion algorithm (Figure 1) and on transfusion practice (Figure 2). 86% of respondents report ROTEM®/TEG® available, 76% haemoglobin tests, 24% quick measurements and 22% Thrombocyte function tests. 6% of the respondents have no point of care test available. A majority of respondents report the possibility to receive more than 10 labile blood products delivered at once (64%). Packed red blood cells are available with a median time delay of 10-15 minutes (Figure 3). For platelets, a median time between ordering and delivery of 15-20 minutes was reported (Figure 4). Discussion The data of our survey reveals wide variability in the logistics of perioperative transfusion and significant subjective influence of these logistic factors. The time to delivery of labile blood products was the most mentioned factor. To our knowledge, this is the first study to evaluate logistic factors with influence on transfusion practice. The principal limitation of our survey is the low response rate. In many situations, the transfusing physician has the consequences of a delayed or omitted transfusion directly in sight, while the consequences of unnecessary transfusions remain diffuse. Those subjective benefits of transfusion might lead to a risk-aversive behavior, as is known from economy and sociology 4. In combination with (perceived) long delivery times, this might be a contributing factor for transfusion incidence. The adaption of institutional processes therefore bear potential benefits for better adherence to transfusion guidelines. In conclusion, transfusion logistics show wide variation across different institutions and are a significant subjective contributor to the individual transfusion behaviour.