Boralessa H, Goldhill D R, Tucker K, Mortimer A J, Grant-Casey J
Department of Transfusion Medicine, National Health Service Blood & Transplant, Brentwood, Essex, UK.
Ann R Coll Surg Engl. 2009 Oct;91(7):599-605. doi: 10.1308/003588409X432464. Epub 2009 Aug 14.
Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice.
NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards.
Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1-14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more.
Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence-based, transfusion threshold should be used and transfusion of more than one unit should only be given if essential to maintain haemoglobin concentrations above this threshold.
血液是一种稀缺且昂贵的产品。尽管输血可能挽救生命，但近年来，人们越来越重视输血的潜在危害，同时也有证据支持采用更低的输血阈值。骨科手术约占输注红细胞的10%，有证据表明输血实践存在很大差异。
英国国民医疗服务体系血液与移植部门与皇家内科医师学院合作，对输血实践进行了全国性审计。要求每家医院提供40例连续接受择期、初次单侧全髋关节置换手术患者的相关信息。将结果与指标和标准进行比较。
对223家医院进行的7465例手术的信息进行了分析。几乎所有医院都有将术前异常血液检查结果提交给医生的系统，73%的医院在手术前进行血型鉴定和血液保存而非交叉配血。47%的医院有输血政策。73%的政策建议输血阈值为血红蛋白浓度8 g/dl及以下。各医院的输血率差异很大。15%的患者在手术前28天内血红蛋白浓度低于12 g/dl，其中57%的患者接受了输血，而术前血红蛋白值较高的患者这一比例为20%。在接受输血的患者中，7%接受了1个单位输血，67%接受了2个单位输血。在术后1 - 14天内接受2个或更多单位输血的患者中，65%输血后的血红蛋白浓度达到10 g/dl或更高。
术前贫血、缺乏输血方案以及使用不同的输血阈值可能导致了输血率的广泛差异。识别和纠正术前贫血的有效措施可能会减少输血需求。应采用一致的、基于证据的输血阈值，只有在维持血红蛋白浓度高于该阈值至关重要时才应输注超过1个单位的血液。
