Abstract
Introduction
A multi-specialized research health center needs to implement a standard blood ordering schedule for elective surgeries and perform regular audits on blood ordering practices to ensure the judicial usage of resources. This retrospective study is a step towards implementing a maximum blood-ordering schedule in our Institute.
Methodology
Blood ordering and utilization of 10 surgical specialties (performing over 180 different surgical procedures) were analyzed for 1 year to formulate an institutional maximum blood-ordering schedule.
Results
Out of 7967 patients, the cross match- transfusion ratio, transfusion probability, and transfusion index were 2.5, 34.5%, and 0.7 respectively. There was a gross over-ordering of blood units pre-operatively (82.4%).
Conclusion
Sixty-seven percent of the elective surgeries can be performed safely with type and screen alone saving 77% of the total expenditure if we were to cross-match the exact number of units demanded. Hence, this study reiterates the importance of regular auditing of blood requisition patterns and the introduction of maximum blood-ordering schedule to prevent wastage of precious blood bank resources.
Similar content being viewed by others
References
Friedman BA, Oberman HA, Chadwick AR, Kingdon KI (2009) The maximum surgical blood order schedule and surgical blood use in the United States. Transfusion 16:380–387. https://doi.org/10.1046/j.1537-2995.1976.16476247063.x
Boral LI, Henry JB (1977) The type and screen: a safe alternative and supplement in selected surgical procedures. Transfusion 17:163–168. https://doi.org/10.1046/j.1537-2995.1977.17277151923.x
Maed JH, Anthony CD, Sattler M (1980) Hemotherapy in elective surgery: an incidence report, review of the literature, and alternatives for guideline appraisal. Am J Clin Pathol 74:223–227. https://doi.org/10.1093/ajcp/74.2.223
Committee TB, for Standards in Hematology Blood Transfusion Task Force, (1990) Guidelines for implementation of a maximum surgical blood order system schedule. Clin Lab Haematol 12:321–327. https://doi.org/10.1111/j.1365-2257.1990.tb00042.x
Frank SM, Oleyar MJ, Ness PM, Tobian AAR (2014) Reducing unnecessary preoperative blood orders and costs by implementing an Updated Institution-specific Maximum Surgical Blood Order Schedule and a Remote Electronic Blood Release System. Anesthesiology 121:501–509
Woodrum CL, Wisniewski M, Truilzi DJ, Waters JH, Alacron LH et al (2017) The effects of a data driven maximum surgical blood ordering schedule on preoperative blood ordering practices. Transfusion Medicine 22:571–577
Vibhute M, Kamnath SK, Shetty A (2000) Blood utilization in elective general surgeries: requirements, ordering and transfusion practices. J Postgrad Med 46:13–17 (http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2000;volume=46;issue=1;spage=13;epage=7;aulast=Vibhute)
Kshirsagar A, Nangare N, Vekariya M, Mahna A, Gupta V et al (2014) Evaluation of Blood Utilization in Elective Surgery- Requirement, Ordering and Transfusion Practices. Int J Health SciRsrch 4:186–199 (http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.658.8705&rep=rep1&type=pdf)
Kaur D, Kandwal M (2016) Blood utilization and quality indicators – trend at a superspeciality hospital in Northern India. HematolTransfusInt J 2:53–56 (https://medcraveonline.com/HTIJ/blood-utilization-and-quality-indicators--trend-at-a-superspecialty-hospital-in-northern-india.html)
Yasmeen I, Ahmed I, Sidhu M (2018) Pattern of blood component cross-matching and their utilization in a tertiary care hospital of Jammu region. Int J Res Med Sci 6:1337–1341. https://doi.org/10.18203/2320-6012.ijrms20181293
Devi KM, Sharma AB, Singh LD, Vijayanta K, Lalhriatpuii ST et al (2014) Quality indicators of Blood Utilization in a Tertiary Care Centre in the North-Eastern India. J Dent Med Sci 13:50–52 (https://www.iosrjournals.org/iosr-jdms/papers/Vol13-issue1/Version-5/L013155052.pdf)
Kumari S (2017) Blood transfusion practices in a tertiary care center in Northern India. J Lab Physicians 9:71–75 (https://www.thieme-connect.de/products/ejournals/abstract/10.4103/0974-2727.199634)
Ransom SB, McNeeley SG, Malone JM Jr (1996) A cost-effectiveness evaluation of pre-operative type-and-screen testing for vaginal hysterectomy. Am J ObstetGynecol 175:1201–1203 (https://www.ajog.org/article/S0002-9378(96)70028-5/fulltext)
Lin JS, Chen YJ, Tzeng CH, Lyou JY, Lee CH (2006) Revisiting of preoperative blood ordering policy – a single institute’s experience in Taiwan. J Chin Med Assoc 69:507–511 (https://www.sciencedirect.com/science/article/pii/S1726490109703193?via%3Dihub)
Jennings JB (1986) An analysis of hospital blood bank whole blood inventory control policies. Transfusion 8:335. https://doi.org/10.1111/j.1537-2995.1968.tb02433.x
Katz AJ, Morse EE (1973) Distribution of fresher blood in a state-wide blood program. Transfusion 13:324–327. https://doi.org/10.1111/j.1537-2995.1973.tb05497.x
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
There is no conflicts of interest among the authors.
Rights and permissions
About this article
Cite this article
Kumar, K., Arcot, P.J. & Coshic, P. Pre-operative blood ordering – Choose wisely!!. Indian J Surg 83, 1373–1381 (2021). https://doi.org/10.1007/s12262-020-02672-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-020-02672-3