Han et al identified risk factors for blood transfusion for patients undergoing nephrectomy for renal cell carcinoma. These can help identify a patient who may need a blood transfusion in the perioperative period. The authors are from the University of California Los Angeles.
Parameters (from multivariate analysis, Table IV page 844):
(1) invasion into the inferior vena cava
(2) type of nephrectomy
(3) ASA classification
(4) preoperative anemia
(5) duration of surgery (OR time)
(6) resection of adjacent organ
|
Parameter |
Finding |
Points |
|
invasion of the inferior vena cava |
absent |
0 |
|
|
present |
1 |
|
type of nephrectomy |
complete |
0 |
|
|
partial |
1 |
|
ASA classification |
ASA 3 |
1 |
|
|
other |
0 |
|
preoperative anemia |
absent |
0 |
|
|
present |
1 |
|
duration of surgery |
not prolonged |
0 |
|
|
prolonged |
1 |
|
resection of an adjacent organ |
no |
0 |
|
|
yes |
1 |
where:
• ASA 4 and 5 comprised only a small percent of the patients. I doubt if a nephrectomy would be performed with an ASA 5.
• Duration of surgery was measured in terms of 15 minutes of OR time. The odds ratio would almost 4 after 1 hour.
• Resection of the adrenal gland is probably not considered resection of an adjacent organ.
• Anemia for a male was < 12.3 g/dL; for a female < 11.5 g/dL.
• Blood loss during and after surgery would be another factor influence the need for blood transfusion.
total number of risk factors =
= SUM(points for all 6 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 6
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
