Blood utilization in elective surgery--requirements, ordering and transfusion practices

Preoperative over-ordering of blood is very common and leads to holding up of the blood bank reserve, ageing of the blood unit and wastage of blood bank resources. We evaluated the preoperative blood-ordering and transfusion practices for common elective general surgical procedures at a major Indian hospital. The principal aim of this study was to identify the surgical procedures where type and screen can be introduced and to formulate a maximum surgical blood-order schedule for those procedures where a complete cross-match appears mandatory.

Six hundred and eighty patients undergoing 21 different surgical procedures between April 1993 and March 1995 were studied. Blood-ordering and transfusion details were noted and the data used to calculate cross-matched to transfused ratio (C/T ratio), transfusion probability (%T) and transfusion index (Ti). The maximum surgical blood-order schedule was calculated using Mead's criterion.

There was gross over-ordering of blood in 10 out of the 21 procedures studied. Three hundred and seventy (40%) of the cross-matches performed were unnecessary. Sixty per cent of the patients studied had blood loss of less than 10% of the total blood volume and 90% of the cross-matches performed for this group were unnecessary. Based on these data, the maximum surgical blood-order schedule was calculated for 11 common surgical procedures.

This study shows that blood was over-ordered in 10 out of the 21 procedures studied. Implementation of the recommended maximum surgical blood-order schedule and introduction of type and screen for eligible surgical procedures is a safe, effective and economic solution to preoperative over-ordering of blood.