Recent publications and recommendations advocate restrictive transfusion strategies, as suggested in patient blood management (PBM) programmes. However, few data are available regarding intraoperative transfusion practices across Europe. The aim of this prospective, observational, multicentre (126 centres in 30 European countries), ESA-endorsed study was to describe intraoperative transfusion triggers and transfusion practices in non-cardiac surgery (excluding cardiothoracic, emergency or trauma surgery).

The key finding of this large study (n=5803 patients receiving at least one RBC transfusion, 1.8% of all screened patients) is that the triggers for intraoperative transfusion appear to be mainly physiological triggers (mostly hypotension), which were considered alone or in combination with other factors in 63.5% of the cases, whereas haemoglobin (Hb) concentrations were considered in “only” 41.4% of the cases (with a mean Hb of 8.1 ± 1.7 g/dL prior to the first RBC transfusion). Nonetheless, Hb seems to be a “hidden” trigger for transfusion since pre-transfusion Hb was around 8.1 g/dL even if when a “physiological trigger” was considered…

Preoperative anaemia was very frequent (82% of these transfused patients were anaemic at the beginning of surgery according to WHO criteria) and remained untreated (less than 1% of the centres used EPO or iron)! In addition, the mean postoperative Hb was relatively high (9.8 ± 1.8 g/dL) and only one third of the patients received 1 unit of blood.

This underscores that the principles of PBM are not applied, despite the fact that 63% of the centres claimed that they used a restrictive transfusion strategy. The results of this large observational study highlight the way to go for PBM.

– Sigismond Lasocki