RED-CELL, PLASMA AND ALBUMIN TRANSFUSION DECISION TRIGGERS

Hypothetical clinical cases were used to investigate transfusion-relat ed decision-making. Three red cell, three fresh frozen plasma (FFP) an d three albumin transfusion decision cases were administered by questi onnaire to 228 medical staff. The transfusion decision triggers were i dentified and comparisons made between resident and specialist groups and between Melbourne and Sydney participants. Factors important in re d cell transfusion decisions included haemoglobin, symptoms of anaemia , presence of co-morbidities or surgery, gender period of hospitalisat ion and the degree of documented blood loss. FFP administration was in fluenced by an abnormal coagulation test, the presence of co-morbiditi es and by the number of red cell units transfused. The administration of albumin, concentrated or 5% SPPS, was influenced by the period of h ospitalisation and clinical circumstances such as a failing urine outp ut postoperatively, and by the presence of hypotensive complications. Different transfusion responses were noted: resident staff transfused red cells and FFP earlier than specialists; Sydney specialists were mo re conservative of red cell transfusion, Melbourne specialists more co nservative of FFP administration and surgeons were four times more lik ely to transfuse patients than physicians or anesthetists at certain h aemoglobin values.