PRESENT STATUS OF BLOOD USAGE IN THE FIELD OF CARDIO-VASCULAR SURGERY IN KANAGAWA PREFECTURE-REPORT OF THE KANAGAWA PREFECTURAL JOINT MEETING OF THE HOSPITAL TRANSFUSION COMMITTEE FOR 2006 FISCAL YEAR

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  • 平成１８年度　神奈川県合同輸血療法委員会神奈川県内における血液製剤の使用量実態調査心臓血管外科領域

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Abstract

The Kanagawa Prefecture Joint Meeting of Hospital Transfusion Committees conducted a questionnaire study of adult cardio-vascular surgeries performed in the 2006 fiscal year. Answers were received from 22 (57.9%) of the 38 hospitals to which the questionnaire was sent. Intra-operative transfusion decisions were made mainly by consensus between the anesthesiologist and chief surgeon (81.8%): 7 of 22 (31.8%) were at a hemoglobin concentration level between 7 to 8g/dl and 5 of 22 (22.7%) were under 7g/dl. The red cell concentrates (RCC) transfusion rates for artificial graft replacement for thoracic aortic aneurysm (TAA) was 85.2%, valve replacement for valvular diseases (valve replacement) was 67.2%, and coronary artery bypass graft (CABG) was 45.6%. Transfusion rates of fresh frozen plasma (FFP), platelet concentrate (PC), and albumin solution (ALB) were in the same order. Average RBC usage for TAA was 16.1±17.6 units (U), valve replacement was 10.4±11.1U, and CABG was 7.3±5.2U. FFP, PC, and ALB were in the same order. The usage difference between hospitals was studied using the formula 90% value/50% value (90/50 ratio). The 90/50 ratios of RBC, FFP and PC usage did not exceed 2.0, except for the RBC for valve replacement and TAA, and for the FFP for TAA. Although there were several hospitals at which no ALB was used, several hospitals regularly used more than 20U of ALB. Significant statistical differences were found between the FFP/RBC ratio and ALB/RBC ratio for TAA (p=0.0106), valve replacement (p<0.0001), and CABG (p<0.0023). Autologous predeposition was done at 13 (59.1%) of the 22 hospitals. The rates of autologous predeposition were 22 of 149 TAA (14.8%), 48 of 183 valve replacements (26.2%), and 24 of 195 CABG (12.3%), with avoidance rates for homologous transfusion for TAA of 40.9% (9/22), valve replacement 54.2% (26/48), and CABG 75.0% (18/24). Our results showed little difference in the usage of RCC, FFP, and PC between hospitals, but a large difference in the usage of ALB. Reducing the usage of ALB in our prefecture is important, and a program to achieve this goal is now being developed.<br>

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