Introduction: Blood transfusion is often required in major surgeries. It is a scarce resource. Also, allogenic blood transfusion in associated with many potential adverse effects. They include acute and delayed hemolytic reactions, infections, fluid overload and many others. Therefore it is crucial that blood transfusion is done judiciously. A critical approach is required where blood transfuion is concerned so as to minimize the adverse effects to the patient. Studies have looked at perioperative blood transfusion practice and have identified inappropriate transfusion rates between 19 and 53% ^1-5. It has been identified that audits regarding blood transfusion practices may help to identify problems in blood tranfusion practice and help to control and decrease rates of inappropriate transfusion ^{2-4, 6-8}. Perioperative blood transfusion is defined as transfusion of RBCs (packed cells or whole blood) during or within 24 hours after surgery.  Based on ASA guidelines, a patient will be considered overtransfused if the post transfusion postoperative haemoglobin concentration is more than 10g%. This cut-off is based on the ASA guidelies , which suggest that patients with Hb more than 10g% almost never need transfusions⁹.   This study is a prospective observational study to observe the existing perioperative blood transfusion practices in our tertiary care institute.

Aims and Objectives: The aim of this study is to evaluate the existing  perioperative blood transfusion practices and the appropriateness of transfusion.

Primary Objective: To ascertain the common indications for which the anaesthesiologists start perioperative blood transfusion and the rates of intraoperative blood overtransfusion.

Secondary Objective: To assess variation in the blood transfusion practices from the standard guidelines.

Methodology: After Ethics Committe approval and informed consent  from anaesthesiologists of the department at GSMC & KEMH, the prospective study would be done over a period of 6 months. Operation theatre anesthesiologists will be given a form to complete for each patient given blood transfusion during elective surgery. The form will ask indications for which they deemed fit to transfuse blood intraoperatively- whether the triggering factor was pallor, hypovolemia, hemodynamic instability, blood loss , haemoglobin level, surgeon’s request or any other reasons.It would include details of the intraoperative blood loss and fluid therapy given. During surgery, two standard size gauze pieces are used.

 Each fully soaked small gauze piece=20 ml

 Each fully soaked large gauze piece=100 ml

Intraoperative blood loss will be calculated by the gauze pieces used during surgery and by measuring the volume of blood in the suction bottle after deduction of any washing fluid given during the surgery.

The immediate post operative haemoglobin of the patient will be documented. From the information obtained, the common indications for blood transfusion in our hospital will be assessed. Based on the level of haemoglobin post operatively, the rate of appropriate blood transfusions will be evaluated. The variation in blood transfusion practices from the standard guidelines will be assessed. The standard indications for blood transfusion include:

1.      Blood loss greater than 20% of blood volume when more than 100ml.

2.      Haemoglobin level less than 8 g/dl

3.      Haemoglobin level less than 10g/dl with major disease (e.g. emphysema, ischemic heart disease)

4.      Hemoglobin level less than 10g/dl with autologous blood.

5.      Haemoglobin level less than 12g/dl and ventilator dependant. ⁹

The protocol and Case record form were discussed and approved by the professors of the department.

Study Design: It is a prospective observational study.

Inclusion Criteria: The anaesthesiologists (faculty and post graduate residents) in department at GSMC & KEMH who give consent for the study.

Blood transfusion given intraoperatively in elective surgeries.

Exclusion Criteria: Anaesthesiologists who refuse consent for the study.

Statistical Analysis: Since this is an observational study, descriptive statistics will be used for the study population and will be expressed as numbers (%) or mean. Chi square test will be used for comparing categorical variables and P value of 0.05 or less considered significant.

Sample size will be 168 according to the formula:

 n=Z² pqN*e²(N-1)+Z²pq

where p= proportion percentage of the most common variable in the population studies

            q= 100-proportion

            e= 5%

            N= Total cases

            Z=1.9