Frequency of Blood Transfusion in Elective Coronary Artery Bypass Grafting and Its Correlation With Acute Kidney Injury at a Tertiary Care Hospital in a Lower Middle-Income Country.

Abstract

BackgroundBlood transfusion remains a significant management aspect in various cardiac surgical procedures including coronary artery bypass grafting (CABG). These patients have a reportedly high incidence of transfusion of blood products. It varies considerably amongst different institutions; most variability being seen in the transfusion trigger. This case series enumerate the frequency of administration of blood products in patients during elective CABG and its association with acute kidney injury (AKI) and ascertain whether blood transfusion is justifiable at a tertiary care hospital.Materials and methodsUsing non-probability consecutive sampling, 172 patients were enrolled in the study. Patient’s preoperative hemoglobin and creatinine, intraoperative hemoglobin, transfusion trigger, number of transfusions (whole blood and packed RBCs-PRBCs), postoperative hemoglobin and creatinine in the ICU and number of transfusions in the first 24 hours were recorded.ResultsOut of the 172 patients, 96 (55.81%) patients received blood transfusion and 73 (42.69%) patients suffered from AKI. 45 (61.64%) patients with AKI received transfusion whereas 28 (38.36%) patients had no transfusion. Of these 96 patients, 45 (46.8%) received transfusion intra-operatively, 24 (25%) patients received both intra-operatively and post-operatively while 27 (28.2%) patients were transfused postoperatively. Majority of the patients, 46 (88.3%), received unjustifiable transfusion (Hb >8 g/dl) during the first 24 hours post-operatively.ConclusionThere is marked divergence in the peri-operative use of blood products that remain on a loco-regional as well as international basis. A standardized and a multidisciplinary strategy as well as robust institutional regulation would significantly reduce inappropriate patient exposure to blood products.