5 de outubro de 2011

Artigo: Accidents by ABO incompatibility and other main complications related to blood transfusion in surgical patients

Data from the French national survey on anaesthesia-related deaths

Dan Benhamou, André Lienhart, Yves Auroy, Françoise Péquignot, Eric Jougla

Transfusion clinique et biologique 12 (2005) 389–390

Blood red cell transfusion often occurs in the perioperative setting and is a frequently performed activity in routine anaesthetic practice. Blood transfusion (including any technique of autologous blood transfusion is performed in nearly 3% of all surgical procedures in France, representing more than 200,000 transfusion procedures each year [1]. Because homologous blood transfusion is performed alone or is associated with any other technique of autologous blood salvage in 48% of cases (i.e. 107,000 patients) and because a mean of three units of red blood cells is used in each patient, it has been estimated that 295,000 packs of red cells are transfused in this country each year. Nearly 50% of these blood transfusion procedures are done during orthopaedic surgery, mainly total hip or knee replacement but one third of the procedures during which blood transfusion is used are emergency procedures [1] and this may have a link with the risk of errors (see below). Along with this, it should be noted that incidents are more often recorded in hospitals in which a small blood bank is used only for emergency situations than in large institutions in which blood transfusion is a routine activity and is used night and day for a large number of patients [2].

Data collected during a national French survey performed in 1997–1998 were aimed at assessing anaesthetic activity but recorded also several indicators reflecting transfusion activities in surgical patients. However, only intraoperative (and recovery room) activities were recorded. As it is well known that nearly 50% of perioperative blood transfusion episodes occur in the first postoperative week [3], it can be estimated that blood transfusion associated with surgical procedures represents more than 500,000 packed red cell units each year in France. These numbers explain why anaesthetists have long been interested in this activity and why the French Society of Anaesthesia and Intensive Care (SFAR) has been involved in (and sometimes has led) many expert conferences on blood transfusion.

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