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

Area of Science:

• Transfusion Medicine
• Surgical Blood Management
• Health Services Research

Background:

• Preoperative blood over-ordering is a widespread issue in healthcare.
• This practice leads to inefficient blood bank resource utilization, including unit aging and wastage.
• Evaluating current practices is crucial for optimizing blood management.

Purpose of the Study:

• To assess preoperative blood ordering and transfusion practices for elective general surgery in India.
• To identify surgical procedures suitable for type and screen protocols.
• To develop a maximum surgical blood-order schedule for procedures requiring cross-matching.

Main Methods:

• A retrospective study of 680 patients undergoing 21 surgical procedures from April 1993 to March 1995.
• Analysis of blood ordering and transfusion data to calculate cross-matched to transfused (C/T) ratio, transfusion probability (%T), and transfusion index (Ti).
• Application of Mead's criterion to calculate the maximum surgical blood-order schedule.

Main Results:

• Significant over-ordering of blood was observed in 10 of 21 procedures, with 40% of cross-matches being unnecessary.
• Patients with blood loss <10% of total blood volume had 90% of their cross-matches deemed unnecessary.
• A maximum surgical blood-order schedule was formulated for 11 common surgical procedures.

Conclusions:

• The study confirmed substantial preoperative blood over-ordering across multiple surgical procedures.
• Implementing the proposed maximum surgical blood-order schedule and type and screen protocols offers a safe, effective, and economical solution.
• Optimized blood ordering reduces waste and enhances blood bank resource management.