Routine pre-operative cross-match for elective colorectal resections: an appropriate use of resources?

our Maximum Surgical Blood Ordering Schedule (MSBOS) recommends that blood is cross-matched prior to elective colorectal resections. National guidelines state that blood should not be cross-matched if blood usage is below 50%. Our aims were to determine compliance with local and national guidelines and assess timing of blood transfusions.

consecutive elective colorectal resections from August 2007 to December 2008 were identified retrospectively using an electronic theatre management system. Patients transfused pre-operatively were excluded. Pre-operative cross-match status and blood transfusion data for each patient were identified using an electronic pathology system and case notes. Cross-match to transfusion (C:T) ratio and blood usage were calculated.

one hundred and thirty one patients were identified. One hundred and sixteen patients (88.5%) had a pre-operative cross-match, 13 patients (9.9%) had a pre-operative group and save and 2 patients (1.5%) had neither a valid cross-match nor group and save. A total of 295 units of blood were cross-matched; 79 units were transfused. Overall C:T ratio was 3.7:1 and blood usage was 26.8%. Twenty eight patients (21.4%) were transfused within 5 days of surgery. Six patients (4.6%) were transfused intra-operatively; 3 (2.3%) post-operatively on the same day; 8 (6.1%) on day one and 11 (8.4%) on or after day 2.

we are over-ordering blood for elective colorectal resections and cannot justify performing a routine pre-operative cross-match. Blood should be grouped and saved pre-operatively and cross-matched only when clinically indicated to minimise inappropriate requests, expenditure and help improve blood stock management.