Perioperative transfusion of red cell products in patients operated at general surgical units of National Hospital of Sri Lanka

Abstract

Indications for red cell transfusion among general surgical patients have changed over time. Despite a scarcity in evidence, many international guidelines advocate a restrictive transfusion protocol.Objectives: To describe the red cell transfusion practices including transfusion thresholds in general surgical wards of a tertiary hospital in Sri Lanka.Methods: A descriptive cross-sectional study was done in all general surgical units of the National Hospital of Sri Lanka, Colombo. All patients transfused with red cell products for a 3-month period from 1/5/2017-1/8/2017 were included in the study. Indications for transfusion, haemoglobin at transfusion and the number of units transfused was the primary data recorded.Results: A total of 196 patients were included in the study. Most transfusions 79.08% (n=155) were for elective reasons. Most elective transfusions were to facilitate chronic extremity wound healing (52.2%, n=81). Most emergency transfusions were for intraoperative bleeding (31.7%, n=13). The majority (73.5%, n=114) of elective transfusions occurred at a Hb of 7-10 g/dL. The mean number of RBC units transfused in elective circumstances for a Hb of 7-10 g/dL was 1.59. A pre-transfusion blood picture was not available in over 85% (n=132) of elective transfusions. Only a single febrile non-haemolytic transfusion reaction was reported.Conclusions: The study revealed substantial divergence of red cell transfusion thresholds in perioperative practice when compared with international guidelines, nonadherence to rational practice such as obtaining a blood picture prior to elective transfusion and therefore the need to formulate local guidelines. It also highlighted the transfusion burden of diabetic foot disease.