Blood use in elective surgical procedures in a “type A” base hospital

Introduction

Blood orders for surgical patients make up a considerable portion of total blood requests but the majority doesn’t lead to a transfusion. Routine crossmatching and reserving blood for all surgeries can be reduced by establishing a Maximum Surgical Blood Ordering Schedule  [MSBOS]. We have analyzed blood utilization in Base Hospital Puttalam and formulated an MSBOS with this study.

Material and methods

A total of 2145 surgeries from surgical and gynaecology & obstetric units in the year 2019 was analyzed. Patients who underwent massive transfusions and patients having a pre-operative haemoglobin concentration less than 8.3g/dl or obtained a pre-operative transfusion were excluded considering transfusions to correct preoperative anaemia. The crossmatch to transfusion ratio [C: T], transfusion probability [T%] and transfusion index [TI] was calculated for each surgical procedure. The procedures having a C: T of >3:1 was recommended for group and screen [G&S]. 

Results

Of a total of 2145 patients, 90% were females. A total of 1565 units were requested and 1521 units were crossmatched for 2034 patients while only 193 were transfused. 

Overall indices for the study population are CT ratio of 7.8:1, %T of 10.4% and TI of 0.15. Indices for surgical unit patients are CT ratio of 5:1, %T of 15.2% and TI of 0.29. By using the MSBOS total of 1403 cross matches could have been avoided.

Conclusions

By implementing the MSBOS 92% of cross matches for elective surgeries could have been avoided. The results are on par with the previous studies done at tertiary health care centres.