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Red blood cell transfusion practices amongst Canadian anesthesiologists: a survey

[Les pratiques transfusionnelles chez les anesthésiologistes canadiens : une enquête]

Alexis F. Turgeon, MD MSc FRCPC^*,, Dean A. Fergusson, PhD, Steve Doucette, MSc, Madhu Priya Khanna, MD, Alan Tinmouth, MD MSc FRCPC^,, Ashique Aziz and Paul C. Hébert, MD MHSC(EPID) FRCPC^,¶

^* From the Critical Care Medicine Program, Centre for Transfusion and Critical Care Research,
Clinical Epidemiology Program, Centre for Transfusion and Critical Care Research;
Program of Urology,
Departments of Hematology, and
^¶ Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Address correspondence to: Dr. Paul C. Hébert, Centre for Transfusion and Critical Care Research, Clinical Epidemiology Program, Ottawa Health Research Institute, General Campus, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6, Canada. Phone: 613-737-8197; Fax: 613-739-6266; E-mail: phebert{at}ohri.ca

Purpose: To assess red blood cell transfusion practices among Canadian anesthesiologists.

Methods: A survey depicting three realistic clinical scenarios of elective surgical procedures with different risks of bleeding was administered to all Canadian practicing members (n = 2,100) of the Canadian Anesthesiologists’ Society. Respondents were requested to choose hemoglobin thresholds for which they would transfuse red blood cells under various conditions within each scenario.

Results: We obtained a response rate of 47% (719/1,512). Transfusion thresholds differed significantly between baseline scenarios. A threshold above 70 g·L^–1 was chosen by 48% of respondents in the general surgery scenario compared to 56% in the orthopedic surgery scenario and 79% in the vascular surgery scenario (P < 0.001). A history of coronary artery disease was associated with a transfusion threshold 100 g·L^–1 in a significant proportion of respondents ranging from 20% in the orthopedic surgery scenario to 31% in the general surgery scenario and to 49% in the vascular surgery scenario (P < 0.001). Conversely, changing the patient’s age from 60 to 20 yr resulted in the adoption of a transfusion threshold 60 g·L^–1 by > 30% of respondents in two scenarios (P < 0.001). The year of respondent graduation was strongly associated with these findings.

Conclusion: There was significant variation in transfusion practices among Canadian anesthesiologists. The type of surgical procedure, patient’s age and a history of coronary artery disease influenced reported transfusion threshold. Practice variation in specific subgroups would support the need for further research to identify optimal transfusion thresholds.

Related articles in CJA:

Optimizing transfusion practice/Une pratique transfusionnelle optimale

Nadine Shehata and C. David Mazer
CJA 2006 53: 331-335. [Full Text]  

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				N. Shehata and C. D. Mazer Optimizing transfusion practice/Une pratique transfusionnelle optimale. Can J Anesth, April 1, 2006; 53(4): 331 - 335. [Full Text] [PDF]