An audit on transfusion of blood products based on clinical judgment in patients undergoing cardiac surgery

Abstract

Background: Transfusion of blood and blood products is strongly associated with increased morbidity and mortality in cardiovascular surgery. This includes transfusion-related acute lung injury, transfusion-associated circulatory overload, renal injury, anaphylactic reactions to blood products, and sepsis. Transfusion of blood products based on the clinician's judgment often results in excessive transfusion. Research suggests that the use of point-of-care (POC) coagulation tests coupled to algorithm-based management decrease transfusion requirements in cardiac surgery. Objectives: To determine abnormal thromboelastograph (TEG) values among patients who received blood products based on clinical judgment and to determine if a POC coagulation test could have resulted in reduced transfusion rates in these patients. Methods: A total of 45 cardiac surgical patients who received blood products during a 3 months period were included in the audit. Coagulation profile and TEG were sent before transfusion for all patients. Data were entered using EPIDATA software. Descriptive analysis was used to define the data. The Fisher exact test was used to assess differences between groups for categorical variables. Results: The R time was abnormal in 4.4% of patients, the Alpha angle was abnormal in 51.1% of patients, maximum amplitude was abnormal in 2.2% of patients, and there was no evidence of fibrinolysis on TEG in these patients. Conclusion: Clinical judgment about the need for blood transfusion had poor correlation with dynamic tests of coagulation. A POC test-based algorithm would have avoided a significant amount of blood product transfusion both in terms of choice of therapy and the dose of component used.