A study of blood utilization pattern among elective surgical patients and formulation of the MSBOS at a tertiary care center

The Maximum Surgical Blood Order Schedule (MSBOS) is a table of elective surgical procedures which lists the number of red cell units routinely cross-matched for them preoperatively. The goal of the MSBOS is to establish realistic blood ordering levels for certain procedures as there are variations in the surgical requirements of institutions. The preoperative blood requests frequently exceed the actual number of units needed for transfusion. The aim of this study was to observe the blood utilization in elective gastrointestinal surgeries in our hospital over a 1-year period.

An institute-based observational study was conducted among patients who underwent elective surgeries under the department of general surgery for gastrointestinal surgical indication over a period of 1 year. The number of units requested, cross-matched, and transfused along with the number of patients cross-matched and transfused were collected. Crossmatch-to-transfusion ratio, transfusion probability, and transfusion index were calculated.

A total of 382 patients underwent 16 different elective procedures, and among these, blood was requested for 347 patients. The number of red blood cell units which were cross-matched for these patients was 721, and out of which, 577 units were transfused to 326 patients. The overall C: T ratio ranged from 1 to 1.34, T% ranged from 88% to 100%, and TI ranged from 1 to 3. All these values were found to be within the acceptable range and indicated adequate blood ordering and utilization pattern. Based on these indices, MSBOS was formulated for each procedure.

The study indicated an adequate overall ratio of C: T ratio, T%, and TI. Developing a blood ordering schedule (MSBOS), to guide the clinicians regarding blood usage can optimize over-ordering of blood, thereby reducing unwarranted compatibility testing, returning unused blood, and wastage due to expiry of the blood units.