Evaluation for Perioperative Blood Transfusion during Major Abdominal Procedures in a Pediatric Population: A Retrospective Observation Cohort Study

The effect of perioperative blood transfusion thresholds on patient outcomes in orthopaedic surgery: a literature review

Blood transfusions are one of the most common interventions required perioperatively in orthopaedic patients. There exist two main schools of thought in relation to perioperative blood transfusion - transfusing at a haemoglobin level of 70 g/L or below (termed 'restrictive protocol' in the literature), versus transfusing at a haemoglobin threshold of 100 g/L (which the literature terms 'liberal'). Few reviews of the literature exist comparing the impact of different transfusion strategies on the postoperative outcomes of these orthopaedic patients. This review analyses the 11 currently available studies on transfusion protocols in orthopaedics and associated findings related to patient outcomes. The literature showed no clear consensus on whether one transfusion protocol is superior in the orthopaedic patient. There was strong evidence for reduced transfusion rates among groups receiving transfusion at <70 g/L, and hence a reduction in complication directly related to transfusions. Despite this, other measured patient outcomes, including length of stay, postoperative complication rate, and mortality rate, were unchanged between the groups. Some evidence exists that a Hb threshold of 100 g/L results in earlier postoperative ambulation in hip surgery patients. One study suggests using preoperative haemoglobin as a preoperative risk factor to aid in determining whether patients are more suited to one approach over the other. Further high-quality clinical trials in orthopaedic cohorts must become available to determine whether a haemoglobin threshold of 70 g/L can safely be adopted to reduce transfusion rates without adversely impacting patient outcomes.

An Observational Study of Paediatric Preoperative Transfusion Practice in a Resource-Limited Setting

Background

Paediatric anaemia is highly prevalent in low–middle-income countries and can negatively impact postoperative outcomes. Currently, there are no guidelines for the management of paediatric preoperative anaemia. To ensure optimal care in resource-limited settings: balancing the risks of anaemia and using resources such as blood transfusion, we first need to understand current practices. To address this, a joint UK–Bangladesh team conducted an observational study at a paediatric surgical centre in Bangladesh.

Methods

A total of 464 patients ≤16 years who underwent elective and emergency surgery were categorised into major (351/464), moderate (92/464) and minor (21/464) surgery groups according to anticipated blood loss. Preoperative anaemia testing and transfusion was assessed retrospectively through patient notes.

Results

Median age was 4 years and 73% were male. 32.5% (151/464) patients had preoperative blood testing for anaemia. 17.5% (81/464) children were transfused preoperatively. Of those children transfused, 40.7% (33/81) underwent transfusion solely based on visible signs of anaemia on clinical examination. Seventy-five percentage (36/48) of children who underwent transfusion after blood testing had haemoglobin ≥80 g/L. Major surgery category had the highest proportion of children who were transfused and tested for anaemia.

Conclusion

A liberal transfusion approach is evident here. Discussion with local clinicians revealed that this was due to limitations in obtaining timely blood results and reduction in laboratory costs incurred by families when clinical suspicion of anaemia was high. Further research is needed to analyse the potential of using bedside haemoglobin testers in conjunction with patient blood management strategies to limit blood transfusions and its associated risks.