EVALUATION OF PACKED RED-BLOOD-CELL TRANS FUSION PRACTICE IN ANESTHESIA AND INTENSIVE-CARE

Objective: To assess the relevance of perioperative packed red blood c ell (PRBC) transfusion practice at the University Hospital of Nice, co mpared with information from the consensus conference on red blood cel l transfusion, held by the French Society of Anaesthesia and intensive Care (SFAR) and the National Agency for the Development of Medical Ev aluation (ANDEM) in December 1993. Study design: Retrospective case se ries analysis. Patients: The study included 240 medical files of surgi cal patients, transfused in 1994 with PRBC, obtained by drawing of lot s following a methodology recommended by ANDEM. Method: A reference li st according to the statement of the consensus conference was designed for the various surgical specialities and the ICU in which PRBC had b een transfused. It included the clinical and laboratory criteria which justified the transfusion, as well as the various categories of PRBC (phenotyped, cytomegalovirus negative, leukocyte-depleted, etc). Autot ransfused PRBC were also considered. The data collected from the medic al files of the 240 patients were compared with the reference list. Re sults: In 84,6% of patients (203/240), the PRBC transfusion had been d ecided with reference either only to a haematocrit level below 0.27 or a level between 0.27 and 0.30 associated with clinical evidence of ba d tolerance of blood loss, according to the reference list. A lack of compliance with the reference list occurred in 15.4% of patients (37/2 40), who had been transfused without any reference to a biological cri terion. Another non compliance existed in 50% of patients (12/24) tran sfused with phenotyped PRBC and in 35.3% (6/17) of those transfused wi th leucocyte-depleted PRBC. An autotransfusion with PRBC had been carr ied out in 30.4% of patients (75/240). Discussion: These deviations of transfusion practice from the consensus conference statement, which w ere more pronounced with phenotyped and leucocyte-depleted PRCB than c onventional PRBC, resulted in the edition of a report, with an analysi s of the causes of deviations and recommendations for all doctors of o ur institution prescribing blood transfusions. Another evaluation, ext ended also to the medical specialities of our hospital and including a ll blood derivates is planned for 1996.