Mastectomy Blood Loss: Can We Predict the Need for Blood Transfusion?

Background: Bleeding during total mastectomy and axillary clearance is inevitable, and blood transfusion is often required when bleeding is excessive. Objectives: To predict the probability of transfusion, we tested the hypothesis: “The blood loss during total mastectomy and axillary clearance in Accra is related to the stage of the disease and the size of the breast”. Design: Patients undergoing total mastectomy and axillary clearance were prospectively studied from June 2008 to June 2011. The breast and used swabs were weighed immediately after surgery, and patients’ full blood count was checked before and after surgery. Setting: Surgical wards and theatres of the Korle Bu Teaching Hospital, Accra. Results: There were 80 women, aged 31 to 85 (Mean 50, SD 3.4) years, with body mass index between 20 and 46 (mean 23.7, median 28). Fifty one (63.8%) had Stage 3 disease, and 47 (58.8%) required neoadjuvant chemotherapy. Pre-operative haemoglobin was 9.5 g/dl to 14.9g/dl (mean 11.6 g/dl, SD 1.1). Post-operative haemoglobin was 9.2 g/dl - 13.4 g/dl (mean 10.9, SD 0.97). The mean drop in haemoglobin level was 0.75 g/dl. None of the 80 patients received blood transfusion. There was a linear increase in breast weight with increasing BMI. Blood loss ranged from 95 g to 1185 g, with majority (59; 73.8%) losing between 100 and 400 gram blood. Only 2 patients (2.5%) lost more than 1000 g of blood. Less than 400 g of blood was lost with breast weights below 2 kg. Above that, blood loss increased to more significant volumes. Conclusions: Blood loss during total mastectomy and axillary clearance in Accra was directly related to the size of the breast. There was, however, inconclusive association between tumour stage and blood loss.