Publication:

Blood loss assessment in abdominal hysterectomy: how accurate?

Background Precise estimation of blood loss is the key to optimal transfusion practice in surgery. Many studies done in various fields of surgery infer that clinical assessment of blood loss by the surgeon or anesthesiologist is inaccurate. The purpose of this study is to see if there is any difference in visual estimation of blood loss and actual blood loss calculated using modification of gross formula in abdominal hysterectomy.

Methods Fifty four patients undergoing total abdominal hysterectomy for various indications at JSS Hospital, Mysore were included in the study. Baseline characteristics, pre-operative haematocrit, clinically estimated blood loss (EBL) and post-operative haematocrit were noted. Actual blood loss (ABL) was calculated from a modification of the Gross formula. The number of cases where the blood loss was clinically underestimated and overestimated; and the relationship between the difference in actual and estimated blood loss and accuracy of clinical assessment of blood loss was determined. The data obtained was analysed using descriptive statistics and Crammer’s V test.

Results In the 54 cases of abdominal hysterectomy which we studied, there was overestimation of blood loss in 28 (51.9%) cases and underestimation of blood loss in 26 (48.1%) cases. The more the inaccuracy in clinical assessment of blood loss, more was the possibility of clinicians underestimating the blood loss.

Conclusions Clinical estimation of blood loss is an inaccurate method of assessing blood loss in abdominal hysterectomy.