In patients without preoperative evidence of myocardial ischaemia undergoing elective hip and knee replacement surgery, a restrictive transfusion strategy seems unlikely to be associated with an increased incidence of SMI. A proportion of these patients experience moderate SMI, regardless of the transfusion trigger. Use of a restrictive transfusion strategy did not increase length of hospital stay, and use of this strategy would lead to a significant reduction in red cell transfusion in orthopaedic surgery. Our data did not indicate any potential for harm in employing such a strategy in patients with no prior evidence of cardiac ischaemia who were undergoing elective orthopaedic surgery.

SummaryThis prospective observational study was conducted to assess the current transfusion practice in critically ill patients. One thousand two hundred and forty-seven consecutive critically ill patients admitted between February 1999 and October 1999 were included in the study. Overall 666 (53%) patients were administered red cells. Transfused patients had signi®cantly higher intensive care unit mortality but also had higher Acute Physiology and Chronic Health Evaluation II scores and longer durations of stay. The average pretransfusion haemoglobin concentration was < 9 g.dl )1 in 75% of transfusion episodes. The common indications for transfusion were low haemoglobin (72%) and haemorrhage (25%). Overall, 202 (16%) and 281 (22%) of the patients were transfused platelets and fresh frozen plasma, respectively. The indications for transfusion were haemorrhage, low platelet counts, prolonged prothrombin time or to provide cover for invasive interventions. Most platelet transfusions were given at values in the order of 50±100´10 9 .l )1 . The pretransfusion platelet count varied according to the indications for transfusion. This study showed that transfusion practice is consistent and that in general there does not seem to be an excessive use of blood components in critically ill patients.

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