Assessment of intraoperative blood transfusion practice during elective non-cardiac surgery in an Indian tertiary care hospital

Background. We assessed appropriate intraoperative use of wholeblood during elective surgery. Methods. This prospective observational audit by a team of anaesthetistsover 3 months in a multi-speciality tertiary care teaching hospitalused strict preset criteria to evaluate the use of blood transfusionduring elective surgery by anaesthetists. The criteria usedto evaluate the rate of appropriate transfusion were haemoglobinless than 8 g dl^–1, haemoglobin less than 10 g dl^–1in patients with medical co-morbidities and blood loss greaterthan 20% of blood volume when more than 1000 ml. Results. The overall rate of appropriate use of blood was 40.7%;it was inappropriate in 19.2% of cases (haemoglobin >11 gdl^–1). The primary trigger was low haemoglobin (measuredintraoperatively or derived from blood loss). Patients in whomhaemoglobin was measured intraoperatively had a significantlyhigher appropriate use of blood (P<0.05). There was a reductionin blood use over the 3-month audit period (P<0.05). Conclusions. Current intraoperative blood use is sub-optimal.Intraoperative haemoglobin estimation is an effective and simplemeasurement to improve appropriate use of blood. The indicationfor transfusion should be recorded in the case notes. Br J Anaesth 2003; 91: 586–9