The practice of patient blood management among South African anaesthetic providers: a cross-sectional study

Abstract

Background: Patient blood management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood while promoting patient safety and empowerment. Thus far, perioperative PBM practices of South African anaesthetic providers have not been described.

Methods: This study prospectively evaluated perioperative PBM practices in South Africa utilising an online survey. In addition, we described the extent to which practices align with the 2020 South African Society of Anaesthesiologists (SASA) and 2014 South African National Blood Service (SANBS) guidelines.

Results: The information letter was opened 573 times, and 403 surveys were more than 50% complete (response rate 70.3%). Most respondents were specialists (54.6%) or specialist trainees (25.1%). Although most providers (89.3%) often or always record preoperative haemoglobin (Hb), only 1% would defer elective surgery (other than caesarean section) if the Hb were < 13 g/dl. Appropriate preoperative anaemia treatment was rarely or never seen by 65.5% of respondents. Only 25.6% of respondents had no access to any point-of-care (POC) test. Most respondents (63.9%) use a transfusion threshold of 7 g/dl for red cell concentrates (RCC) in non-cardiac patients. Few respondents often or always use cell salvage in non-obstetric surgery, where blood loss > 500 ml is anticipated (21.2%), or in major obstetric haemorrhage (21.2%). In major haemorrhage, most respondents often or always monitor for, treat, and prevent hypothermia (97.5%), acidosis (96.0%), hypocalcaemia (90.0%), and hyperkalaemia (91.6%). Tranexamic acid (TXA) is often or always used in severe trauma (70.7%) and major obstetric haemorrhage (72.1%).

Conclusion: Rational blood usage practices among respondents were reasonably good; however, PBM practices were poor and did not align with South African guidelines. Preoperative anaemia management requires improvement, including facilities to identify and treat anaemic patients preoperatively.