A retrospective study of empirical transfusion of blood products during cardiac surgery measured by thromboelastometry; Is it time to change?

Abstract

Background & objective: Despite an international effort lead by the World Health Organization (WHO) many cardiac centers still continue the practice of empirical blood product transfusion. Current guidelines and published evidence strongly support the use of transfusion algorithms that are guided by point-of-care coagulation testing. The aim of this study is to determine the proportion of patients with normal coagulation parameters who still received empirical blood products during cardiac surgery. Secondary end point is the occurrence of transfusion-related adverse events.

Methodology: This is a retrospective observational study of 100 pediatric patients scheduled for cardiac surgery. As part of the rotational thromboelastometry (ROTEM) introduction to the operating theatre, two ROTEM samples were collected, before and after blood products. The empirical blood products practice continued as usual and did not change based on those ROTEM samples.

Results: Among patients who received empirical blood products, 16% had normal fibrinogen levels (did not need Cryoprecipitates), 24% had normal clotting factors (did not need fresh frozen plasma) and 60% had normal platelets assessment. No significant adverse events attributable to blood products were observed.

Conclusion A proportion of pediatric patients had normal coagulation parameters prior to the administration of empirical blood products. The study highlights the value of viscoelastic point-of-care testing to avoid unnecessary transfusion during cardiac surgery. It underscores the urgent need to transition institutional practice towards algorithm-based approach and appropriate use of blood components.

Abbreviations: FFP: Fresh frozen plasma. ROTEM: rotational thromboelastometry, WHO: World Health Organization,  TACO: Transfusion-associated circulatory overload, TRALI: Transfusion-related lung injury

Keywords: Blood coagulation; Cardiac surgery; Cardiopulmonary bypass; Fresh frozen plasma; Point of care; : Rotational thromboelastometry.

Citation: Elsherbeny A, AbdelAal I, Abuzaid A, Abdalwahab A. A retrospective study of empirical transfusion of blood products during cardiac surgery measured by thromboelastometry; Is it time to change? Anaesth. pain intensive care 2026;30(3):314-318. DOI: 10.35975/apic.v30i3.3168

Received: December 23, 2025; Revised: March 06, 2026; Accepted: March 11, 2026