Adjusted transfusion triggers improve transfusion practice in orthopaedic surgery

• Published in: Transfusion medicine (Oxford, England) Vol. 15; no. 1; pp. 13 - 18
• Main Authors: Eindhoven, G. B., Diercks, R. L., Richardson, F. J., Van Raaij, J. J. A. M., Hagenaars, J. A. M., Van Horn, J. R., De Wolf, J. Th. M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Blackwell Science Ltd 01-02-2005
• Subjects: Aged; Arthroplasty, Replacement, Hip - standards; Blood Loss, Surgical - prevention & control; blood transfusion; Blood Transfusion, Autologous - standards; Elective Surgical Procedures - standards; Erythrocyte Transfusion - standards; Female; guidelines; Humans; Male; Middle Aged; orthopaedic surgery; Practice Guidelines as Topic - standards; transfusion triggers
• ISSN: 0958-7578; 1365-3148
• DOI: 10.1111/j.1365-3148.2005.00543.x

Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6‐8‐10‐Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case–control study in patients undergoing elective primary total hip replacement. The study consisted of two parts. In the first part, physicians were strongly encouraged to use the new guidelines; in the second part, only registration took place. During the first and second part of the study, the use of packed red cells (PRC) in Hospital A (study hospital) decreased from 1·1 ± 1·5 to 0·6 ± 1·2 and 0·3 ± 0·9 units, whereas in Hospital B (control), the use of PRC remained unchanged (1 ± 1·5, 1 ± 1·7 and 1 ± 2 units). In the prestudy groups, 43% of the patients in Hospital A were transfused compared to 45% in Hospital B. In the first and second part of the study, 27%, respectively, 14% of the patients in Hospital A were transfused compared to 40% in both periods in Hospital B. The new guidelines lead to a reduction in the use of allogeneic blood and a decrease in the number of patients transfused.