Optimal hemotherapy in elective surgery

The transfusion incidence and the crossmatch/transfusion ratio are expected to provide objective guidelines for hemotherapy in elective surgery. For those surgical procedures which rarely require hemotherapy an ABO Rh-D typing and an antibody screening test without a crossmatch were recommended as preoperative tests. For surgical procedures with a moderate to high transfusion incidence it is suggested that the number of units to be crossmatched preoperatively should be equal to the average number of units transfused for that procedure in the past. Under conditions of normovolemia and normal cardiopulmonary function initial blood loss up to two units can readily be replaced by colloid solutions. For medical reasons transfusion of packed red cells are preferred to whole blood. supply of whole blood is only needed when rapid replacement of large amounts of blood is imminent or expected. The use of a surgical blood order schedule (SBOS) is very useful to reduce excessive preoperative crossmatching. The establishment of appropriate guidelines and recommendations can lead to an increase in quality and safety of blood transfusion and substantial economic savings.