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abstract
Objectives
Blood products are
scarce but essential medical resources. Initially transfusions showed
increased perioperative complications, prolonged hospitalizations, and
higher mortality. Recently developed restrictive transfusion policies
have not shown those adverse affects in critically ill patients.
Hospitals adopted these policies to guide blood product administration.
The objective of this study is to determine compliance with a
restrictive transfusion policy in gynecologic oncology patients.
Methods
A
retrospective chart review of gynecologic oncology patients undergoing
transfusion with packed red blood cells (pRBCs) from 12/2008-9/2011 was
performed. Cancer type and stage, surgical procedure, hemoglobin values,
pRBC transfusions, intraoperative blood loss, and postoperative
complications were collected. Each transfusion was classified as
compliant or noncompliant.
Results
582
patients requiring 2,276 blood transfusions were identified. The mean
age was 55.9 years. Ovarian and endometrial cancers were the most common
malignancies. Gynecologic oncologists were 81.1% compliant with the
restrictive transfusion policy; 59.0% of transfusions were secondary to
exceptions. Noncompliant transfusions were commonly given on the day of
surgery when intraoperative blood loss was < 1500 cc and for
asymptomatic anemia. Only 64.7% of the transfusions were ordered in
single unit increments. There was no significant difference in
postoperative infections, thrombotic events, and mortality between
compliant and noncompliant transfusions.
Conclusion
The
majority of gynecologic oncology patients receive transfusions
compliant with the restrictive transfusion policy. Morbidity and
mortality are not increased with a restrictive transfusion policy.
Efforts to improve compliance should focus on limiting transfusions when
the hemoglobin is ≥ 7 g/dL and transfusing in single pRBCs unit
increments.
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