An observational study of intraoperative transfusion management in a cardiac surgical unit in Trinidad and Tobago / Estudio observacional del manejo de la transfusión intraoperatoria en una unidad de cirugía cardíaca en Trinidad y Tobago

OBJECTIVE: To investigate the intraoperative transfusion requirements in off-pump coronary artery bypass grafting (OPCABG) and the cost implication of blood products and cell savers on a background of limited resources. METHODS: Prospective data collection identified 60 patients undergoing OPCABG surgery at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Data relating to these patients (including preoperative haemoglobin (Hb), graft number, presence of diabetes, ejection fraction, preoperative serum creatinine, intraoperative blood use and blood loss) and costing for cell saver disposables and prepared donor (or allogenic) blood were obtained. RESULTS: Twenty units of packed red blood cells (pRBCs) were given in theatre to 27% (16 of 60) of patients. Transfusion requirement was significantly lower in patients with fewer grafts, higher pre-operative Hb level and non-diabetic patients. Cell saver disposables and one unit of pRBCs were estimated to cost TT$5000 and TT$1700, respectively. Each patient's transfusion cost TT$2125.00 per unit. CONCLUSION: The study demonstrates the financial implications of routine cell saver use in OPCABG in a setting oflimited resources. The cost-effectiveness ofroutine cell saver use remains to be elucidated, but we recommend the selective use of cell savers in patients who are at a higher risk for transfusion.

OBJETIVO: Investigar los requisitos de la transfusión intra-operatoria en el bypass coronario con injerto sin circulación extracorpórea (OPCABG), y la implicación del costo de los hemoderivados y los recuperadores celulares en un contexto de recursos limitados. MÉTODOS: La recopilación de datos prospectivos identificó a 60 pacientes sometidos a cirugía OPCABG en el Complejo de Ciencias Médicas Eric Williams, en Trinidad y Tobago. Se obtuvieron datos en relación con estos pacientes (incluyendo la hemoglobina preoperatoria (Hb), número de injertos, presencia de diabetes, fracción de eyección, creatinina sérica preoperatoria, uso y pérdida de sangre preoperatorios) así como el costo de todos los recuperadores celulares desechables, y la sangre del donante preparada (o alogénica). RESULTADOS: Veinte unidades de glóbulos rojos empaquetados (pRBCs) fueron transfundidas en el salón de operaciones al 27% (16 de 60) de los pacientes. La necesidad de la transfusión fue significativamente más baja en los pacientes con menos injertos, nivel preoperatorio de hemoglobina (Hb) más alto, y en los pacientes no diabéticos. El costo de los recuperadores celulares desechables y una unidad de pRBCs fueron estimados en 5000 TTD y 1700 TTD, respectivamente. La transfusión de cada paciente costó 2125 TTD por unidad. CONCLUSIÓN: El estudio demuestra las implicaciones financieras del uso de recuperadores celulares de rutina en el OPCABG en un contexto de recursos limitados. El costo-efectividad del uso de los recuperadores celulares de rutina sigue siendo un asunto que necesita aclaración. No obstante, se recomienda el uso selectivo de recuperadores de células en pacientes con alto riesgo a causa de la transfusión.

An observational study of intraoperative transfusion management in a cardiac surgical unit in Trinidad and Tobago.

OBJECTIVE: To investigate the intraoperative transfusion requirements in off-pump coronary artery bypass grafting (OPCABG) and the cost implication of blood products and cell savers on a background of limited resources. METHODS: Prospective data collection identified 60 patients undergoing OPCABG surgery at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Data relating to these patients (including preoperative haemoglobin (Hb), graft number, presence of diabetes, ejection fraction, preoperative serum creatinine, intraoperative blood use and blood loss) and costing for cell saver disposables and prepared donor (or allogenic) blood were obtained. RESULTS: Twenty units of packed red blood cells (pRBCs) were given in theatre to 27% (16 of 60) of patients. Transfusion requirement was significantly lower in patients with fewer grafts, higher preoperative Hb level and non-diabetic patients. Cell saver disposables and one unit of pRBCs were estimated to cost TT$5000 and TT$1700, respectively. Each patient's transfusion cost TT$2125.00 per unit. CONCLUSION: The study demonstrates the financial implications of routine cell saver use in OPCABG in a setting of limited resources. The cost-effectiveness of routine cell saver use remains to be elucidated, but we recommend the selective use of cell savers in patients who are at a higher risk for transfusion.

Efficacy and cost analysis of treating very low birth weight infants with erythropoietin during their first two weeks of life: a randomized, placebo-controlled trial.

OBJECTIVE: We hypothesized that using a higher dose of erythropoietin (Epo) and starting treatment on the first day of life would reduce the transfusion requirements of ventilator-dependent and non-ventilator-dependent very low birth weight (VLBW) infants. Moreover, we hypothesized that this treatment would be cost-effective. METHODS: We randomly assigned 20 ill newborn VLBW infants to receive either Epo (200 units/kg per day) or placebo during their first 2 weeks of life. The caregivers were unaware of the treatment assignments, and erythrocyte transfusions were administered according to hematocrit and signs of anemia. RESULTS: On day 1, reticulocyte counts and hematocrits were similar in the two groups. During the subsequent 2 weeks, reticulocyte counts of the placebo recipients fell significantly below those of the Epo recipients, but hematocrits in the two groups did not differ. More transfusions were received by the placebo recipients (mean = 1.4 per patient) than by the Epo recipients (mean = 0.2 per patient; p < 0.01). No adverse effects of Epo were noted, and the costs in the placebo group exceeded those in the Epo group. CONCLUSIONS: We conclude that administration of Epo to VLBW infants during the first 2 weeks of life results in fewer transfusions and is cost-effective.