Routine blood transfusion should not be "routine" in cardiac surgery

Abstract

Objective: To determine if open-heart surgery can be performed in a public hospital in Pakistan without the use of routine blood transfusions. Considering the high prevalence of Hepatitis B and C in the donor population, decreased use of donated blood is the best protection against these and other transfusion transmitted infections. Design: Cross sectional observational study. Place and duration of study: This study was conducted at cardiac surgery department, Mayo Hospital Lahore. It included patients operated from January 2006 to September 2006. Duration of study was 9 months. Material and Methods: Total of 106 patients undergoing open-heart surgery were included in the study. These were all adult patients operated during the first nine months of 2006 by a single group of surgeons. Patients who were re explored for bleeding or had complicated postoperative course or who did not survive the operation were excluded. All the pump blood after cessation of cardiopulmonary bypass was transfused to the patient. Intra and post-operative allogeneic blood transfusions were given based upon strict transfusion criterion. Any patient who received 1 unit of blood` or 2 units of blood with post operative haemoglobin of 11 gram per 100 ml or more than 11 gram per 100 ml or more than 2 units of blood with post operative haemoglobin of 12 gram per 100 ml or more than 12 gram per 100 ml was considered to have received unnecessary transfusions 2. Results: 67 patients (63.21%) did not receive any blood transfusions. 32 Patients, (30.19%) were transfused 2 units of blood. 7 (6.60%) patients received more than two units of blood. 8 (7.55%) patients received unnecessary transfusions. Conclusions: Blood transfusions can be eliminated in most routine cardiac operations. As appropriate drugs and technology like cell savers and in pump haemo-concentration devices become available to us, the number of patients receiving blood transfusions can most likely be decreased further.