Blood transfusion policies in elective general surgery: how to optimise cross-match-to-transfusion ratios.

Hall TC, Pattenden C, Hollobone C, Pollard C, Dennison AR
Transfus Med Hemother 2013;40:27-31.
NATA Rating :
Review by : G. Inghilleri
NATA Review

This retrospective data analysis, carried out in a single university teaching hospital in the field of elective general surgery, indicates that appropriate ordering of blood components in transfusion practice remains a problem and that over-ordering is still the norm. Since the seventies, methods such as the maximum surgical blood order schedule (MSBOS) and the type and screen procedure (T&S), also commonly referred to as group and safe test, have been proposed and a huge number of studies have shown their safety and efficacy in optimizing blood management and in reducing wastage and costs. Moreover, recently, appropriately performed T&S procedures (including ABO and RhD group, red cell antibody screen, checking for previous records and electronic cross-match) without serologic cross-matching is becoming the standard pre-transfusion test in surgical patients (with the exception of those who have a positive red cell antibody screen) in an increasing number of hospitals in different countries.

In this study, the authors evaluated all elective general procedures carried out in their institution over a 6-month period (541 patients) and found that, overall, the number of blood units cross-matched (i.e. requested before surgery) was more than double the number of units actually transfused, resulting in a cross-match-to-transfusion ratio (C:T) of 2,1:1. In some types of surgery the C:T ratio reached values higher than 6. The study also shows a very inappropriate request of the T&S procedure in minor surgery. The relevance of this study is limited by the short period of time examined and the small number of cases analyzed; however, it reminds us that, in an age in which a lot of attention is directed to the appropriateness of transfusion indications, efforts must still be dedicated to appropriateness of blood ordering.

– Giovanni Inghilleri

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