Blood transfusion in bimaxillary orthognathic operations: need for testing of type and screen

We prospectively evaluated the incidence of blood transfusion in 105 consecutively treated patients (45 men and 60 women) having bimaxillary orthognathic operations, to find out whether type and screen testing are adequate in clinical practice. All patients had Le Fort I osteotomy combined with bilateral sagittal split osteotomy of the ramus. The preoperative routine was restricted to type and screen testing and verification of ABO/Rhesus (Rh) status. Autologous blood donation or routine cross-matching of allogeneic units of blood was not done. Intraoperative haemoglobin concentrations and the need for blood transfusion in patients having bimaxillary osteotomies were recorded in a prospective database. The mean duration of operation was 196 min (range 115-325). The median length of hospital stay was 8 days (range 4-16). The mean (SD) reduction in haemoglobin during operation was 34 (16)g/L in men and 32 (10)g/L in women (p=0.32). No patients had an allogeneic blood transfusion. We found that type and screen testing and verification of ABO/Rh status seems to be an adequate precaution to manage blood loss. As reflected by the low rate of transfusion in the present study, severe haemorrhage that requires transfusion of allogeneic blood has become the exception rather than the rule in bimaxillary orthognathic operations.