Critical Care and Shock

Transfusion practices among the neurosurgical community of Puerto Rico



Objective: The use of PRBC includes health risk and has other significant implications. Our objective was to characterize and define the clinical factors that influence PRBC transfusion practice.

Design: Prospective study using a validated 11 item questionnaire administered to 43 physicians.

Setting: University of Puerto Rico, Neurosurgery Department.

Patient and participants: Population included attending physicians (AP) and residents (R).

Interventions: Questions included decision making logistics and therapeutic elements: general demographics, reasons for transfusion, quantity given, transfusion threshold, and the expected appropriate hemoglobin (Hb) level for patients with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), with coronary artery diseases (CAD) or without CAD.

Measurements and results: Fifty three percent neurosurgeons responded the questionnaire. 65% were AP and 33% were R. 43% of AP vs 25% of R transfused to increase oxygen delivery, 50% of R vs 38% of AP transfused to avoid ischemic injury, 50% of both AP and R considered that age and disease severity may interfere with adaptation of anemia, therefore needing transfusion, and 50% of AP vs 38% of R to improved safety margin anticipating further blood loss. Threshold for transfusion was a Hb level of 8-10 g/dL (36%) or <7 g/dL (41%). 77% of AP and 63% of R thought the appropriate level of Hb in SAH was 10-12 g/dL. 65% of AP thought that in TBI Hb level should be between 10-12 g/dL and 38% of R answered 8-12 g/dL. 63% of R thought that the appropriate Hb for a post-op patient with CAD was between 10-12 g/dL and 46% of AP answered 10-12 g/dL or >12 g/dL. The appropriate Hb for post-op patient without CAD was 10-12 g/dL, and there was no significant difference between AP and R.

Conclusions: Recognizing when to transfuse blood in a neurological critical care patient remains a clinical challenge. Frequent and unwarranted transfusions may worsen outcome of patients. More studies regarding transfusion recommendations in neurological critical care are needed.

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