Transfusion Algorithm Reduces Use of Allogeneic Nonerythrocyte Components. Nuttall et al. (page 773)

Among 836 enrolled adult patients who had elective cardiac surgery necessitating cardiopulmonary bypass, abnormal bleeding developed in 92 (11%). In a randomized trial, Nuttall et al.  compared the impact of different allogeneic transfusion practices in these 92 patients.

After the diagnosis of abnormal bleeding was made, patients were assigned randomly to one of two groups. In the control group, decisions for transfusion of blood components (platelets, fresh frozen plasma, or cryoprecipitate) were left to the discretion of the individual anesthesiologists, with or without guidance from laboratory tests. Transfusion therapy in the protocol group was guided by an algorithm based on coagulation tests. Allogeneic platelets were administered if the platelet count was less than 102,000/μl or the maximum amplitude of the thromboelastogram was less than 48 mm. Fresh frozen plasma was transfused if the prothrombin time was greater than 16.6 s or the activated partial thromboplastin time was greater than 57 s. Cryoprecipitate was transfused if fibrinogen was less than 144 mg/dl.

Results showed that patients in the transfusion algorithm group received less allogeneic fresh frozen plasma in the operating room after cardiopulmonary bypass than did the patients in the control group. Platelet transfusions were also less frequent in the protocol group, and these patients experienced less blood loss in the intensive care unit. Patients in the control group also had a significantly greater incidence of surgical reoperation of the mediastinum for bleeding (11.8%vs.  0%). Although the authors recommend a multicenter study to address institutional variances in transfusion practices, they believe that use of an algorithm based on similar measurements could improve transfusion decisions.