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Audit on the efficient use of cross-matched blood in elective total hip and total knee replacement
1Department of Trauma & Orthopaedics, Stoke Mandeville Hospital, Buckinghamshire, UK.
Insights
Implementing new transfusion guidelines significantly reduced unnecessary cross-matched blood use in total hip (THR) and total knee (TKR) replacement surgeries. This optimized blood resource management and demonstrated cost benefits.
Area of Science:
- Transfusion Medicine
- Surgical Blood Management
- Orthopaedic Surgery
Background:
- Prospective audit of cross-matched blood utilization in 301 patients undergoing total knee (TKR) and total hip replacement (THR) surgery.
- Initial analysis revealed a high incidence of unnecessary cross-matched blood usage.
Purpose of the Study:
- To evaluate the impact of revised transfusion protocols on blood utilization in TKR and THR procedures.
- To assess the effectiveness of interventions aimed at reducing unnecessary cross-matched blood.
Main Methods:
- Ceased routine cross-matching for THR procedures.
- Implemented post-operative full blood count checks on day 2.
- Established a transfusion trigger of Hb < 8 g/dl for patients over 65 without significant co-morbidity.
Main Results:
- Reduced unnecessary cross-matched blood by 96% for THR.
- Lowered the cross-match to transfusion (C:T) ratio from 3.21 to 1.62 for THR.
- Observed similar reductions in blood utilization for the TKR cohort.
- Survey indicated many hospitals still routinely cross-match blood for THR and TKR.
Conclusions:
- Revised transfusion protocols, aligned with national guidelines, significantly improve blood resource management.
- Maximum Surgical Blood Ordering Schedules (MSBOS) can be safely modified in orthopaedic units.
- Substantial risk and cost benefits are achievable through optimized blood utilization.
Introduction:
This prospective audit studies the use of cross-matched blood in 301 patients over a 1-year period undergoing total knee (TKR) and total hip replacement (THR) surgery in an orthopaedic unit.
Patients And Methods:
Analysis over the first 6 months revealed a high level of unnecessary cross-matched blood. The following interventions were introduced: (i) to cease routine cross-matching for THR; (ii) all patients to have a check full blood count on day 2 after surgery; and (iii) Hb < 8 g/dl to be considered as the trigger for transfusion in patients over 65 years and free from significant co-morbidity. These changes are in accordance with published national guidelines [Anon. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113: 24-31].
Results:
In the next 6 months, the number of units cross-matched but not transfused fell by 96% for THR, and the cross-match transfusion (C:T) ratio reduced from 3.21 to 1.62. Reductions were also observed for the TKR cohort. These results provide evidence of a substantial risk and cost benefit in the use of this limited resource. A telephone survey of 44 hospitals revealed that 20 hospitals routinely cross-matched blood for THR and 11 do so for TKR.
Conclusions:
Changes can be made to the Maximum Surgical Blood Ordering Schedules (MSBOS) in other orthopaedic units according to national guidelines.
