Transfusion policies in coronary artery bypass — a nationwide survey in Finland

Background : Since the discovery of HIV, minimizing the use of donor blood has become increasingly important in surgical activity. In Finland, however, the use of homologous red blood has grown considerably during the past years. Therefore, we found it necessary to conduct a nationwide survey of transfusion practices in elective surgery. This report deals with transfusions in coronary artery bypass (CABG) operations in all Finnish cardiac centres.
Methods : The study group comprised 804 primary CABG patients operated during a 2-year period. Two reviewers retrospectively examined the data concerning the use of and indications for homologous and autologous blood in the patient charts.
Results : In all, 705 (88%) of patients received homologous blood. The proportions of patients receiving blood components differed between hospitals: from 53 to 99% for red cells, 2 to 22% for fresh frozen plasma and 5 to 49% for platelets. The variation was not caused by diverse patient populations: the mean number of blood component units transfused per patient differed from 1 to 6 between centres — even after adjustment for confounding variables. Multiple blood conservation methods were used in one centre. Nevertheless, homologous blood was administered to 88% of their patients.
Conclusions : A considerable proportion of CABG patients are transfused with homologous blood in Finland compared to other countries. In addition, the transfusion practices proved highly variable between hospitals and were determined largely by local opinions. This study reveals a clear demand for prospective studies and constructive discussion among anaesthesiologists to establish uniform guidelines for blood use in cardiac surgery.