九州大学医学部附属病院における術中輸血の現状

抄録

To understand the strategy of anesthesiologists regarding intra-operative transfusion, we analyzed cases at Kyushu University Hospital. During the last four months, intra-operative blood transfusions were performed in 172 out of 1, 525 (11.3%) surgical operations done in our operating room. Among these 172 cases, as many as 30% (55 cases) were managed by autologous transfusions, either preoperative deposition or intra-operative cell saving. For red cell transfusion, red cell concentrates derived from 400ml of donated blood were used in most cases (224/236, 95%). The critical hematocrit level at which anesthesiologists introduced blood transfusion was 25%, instead of 30%, the generally accepted level. All platelet transfusions were done with platelet concentrates obtained by single donor apheresis. These results indicate that adverse reactions of homologous blood transfusions such as post-transfusion hepatitis or post-transfusion graft-versus-host disease are well understood by anesthesiologists, and efforts to reduce transfused blood units were made. Only 15% of all transfused blood units were of fresh frozen plasma. This means that anesthesiologists recognized that fresh frozen plasma should be used to supplement coagulation factors. However, one of the problems to be settled is the overuse of albumin solutions. In the present series, 5% albumin solutions were administered in over 60% of transfused cases to maintain colloid osmotic pressure, but many cases could have been managed by alternative measures.