Rational blood transfusion in elective gynecologic surgeries in a tertiary hospital in the Philippines

BACKGROUND: Blood transfusion plays a vital role in modern health care; however, local studies on the utilization of blood products intra-operatively, especially in elective gynecologic surgeries, are lacking. OBJECTIVE: To determine the blood transfusion use during elective gynecologic surgical cases performed at a tertiary hospital in the Philippines. Methods: This retrospective descriptive study included data from patients admitted for elective gynecologic surgeries between January 2019 – December 2019. Pertinent data was gathered from the admission charts, preoperative laboratory results (hemoglobin levels, prothrombin time, partial thromboplastin time), blood bank records of deposited/donated blood and crossmatched units, anesthesia as well as intra-operative records, and medical charts. All abstracted variable were analyzed and transfusion indices were calculated. RESULTS: Majority of the patients who underwent elective surgeries were from the general gynecologic service (60.4%), with abdominal hysterectomies comprising majority of the transfused patients. The calculated crossmatched-to-transfused ratio (C/T ratio) for pRBCs, FFPs, and PCs are 5.1, 7.6, and 19.7; the transfusion indices are 0.57, 0.44, and 0.17, while transfusion probabilities are 28.1%, 10.4%, and 4.2%, respectively. We found a significant association between transfusion status and primary service (p = 0.01), previous pregnancy (p = 0.02), preoperative hemoglobin count (p < 0.01), preoperative hematocrit (p < 0.01), postoperative hemoglobin count (p < 0.01), postoperative hematocrit (p < 0.01), and intra-operative blood loss (p < 0.01). CONCLUSION: There is consistent over-ordering of blood products. Primary gynecologic service, previous pregnancy, preoperative hemoglobin and hematocrit, as well as introperative blood loss are factors associated with transfusion status.