Rationale for blood request: cross match versus group and screen
Abstract
Introduction Adherence to guidelines for the cross-matching and reservation of blood for surgical procedures will optimize the utilization of resources. The objective of this study was to evaluate the practice of cross-match and utilization of blood for elective surgeries in a tertiary Sri Lankan surgical unit using the following criteria: cross-match to transfusion ratio (C/T ratio) ≤ 3.0, transfusion probability (%T) ≥30 and transfusion index (TI) ≥0.5.
Material and methods A retrospective analysis of 104 patients who underwent elective surgical procedures at the Professorial Surgical Unit, Colombo during the period of January-September 2011 was done. Data was obtained from patient records. Blood utilization was evaluated using the following indices: C/T ratio, %T and TI.
Results Of the 104 patients, 96(92.3%) had a cross-match and 8 (7.69%) had only a group and screen. The cumulative non-utilisation of cross-matched blood was 107/126 (84.9%).All procedures studied had a CT ratio > 3 and a TI < 0.5 i.e. beyond the criteria of justification for a crossmatch. Large bowel surgeries, mastectomies and oesophagectomies marginally matched the criteria justifying a crossmatch only in respect to the %T, with values just above 30%.
Conclusion This data suggests that unwarranted cross-matching of blood is done in most procedures, especially cholecystectomies, fundoplications and thyroidectomies where a group and screen is adequate. We recommend further study of this issue and the development of evidence based blood ordering schedules in each hospital.
Sri Lanka Journal of Surgery 2013; 31(3): 24-27
© 2014 Chanika A Gamage, P Pratheepan, S Sivaganesh, published by The College of Surgeons of Sri Lanka
This work is licensed under the Creative Commons License.