Cross-match Transfusion Research Articles

Spontaneous Splenic Rupture: Case Report from Yekatit 12 Medical College Hospital, Addis Ababa, Ethiopia

Splenic rupture can be traumatic or non-traumatic (spontaneous). The spleen is the commonest solid organ injured in blunt abdominal injury. Spontaneous splenic rupture is rare and one cause of acute abdomen which can lead to morbidity and mortality. Among patients having spontaneous splenic rupture, majority of them have underlying splenic pathology of different causes such as hematologic, infectious, inflammatory, drugs or mechanical. In endemic area of malaria, spontaneous splenic rupture is one of fatal complication of severe malaria fortunately it is rare complication. In rare cases there may be no splenic pathology identified which is called idiopathic. The treatment of ruptured spleen is mainly splenectomy though there are cases reports of angioembolization as treatment option. Here we present a case report of 20 year old male patient who presented with diffuse abdominal pain of 3 days duration with signs of generalized peritonitis. During exploratory laparotomy, he was having ruptured spleen with blood in the peritoneum. He was managed with splenectomy and cross match transfusion after the bleeding was controlled. The patient was discharged improved after he took pentavalent vaccine. In conclusion, though spontaneous splenic rupture is rare over all there are different case reports of this condition and one has to consider it as differential diagnosis in patient who presented with acute abdomen of unclear causes and especially if the patient has underlying diseases or drugs that can affect the spleen.

Red cell requisition and utilization pattern in a tertiary care hospital of South India.

The equilibrium between supply and demand for red blood cells is increasing unpredictably in many countries. An understanding of trends in blood usage profile and current usage can help predict future trends in demand and to put efforts to reduce use in particular areas. This study helps in analyzing the pattern of red blood cell utilization in a tertiary care hospital. This retrospective study was conducted in a blood bank, tertiary care hospital over a period of 6 months. All the requests coming to blood bank with information regarding patient's demographic details, diagnosis and indication for transfusion, type of request, blood transfused or returned were collected and reviewed. Crossmatch transfusion (CT) ratio, transfusion index (TI), and transfusion probability were also calculated. A total of 10,364 patients (20,399 requests) utilized total 32,608 units of blood and its components, out of those 14,195 units of packed red cells units were utilized. March month had maximum number of requests and utilization. Most of the requests for blood were from the inpatients (wards) and were requested and utilized in the age group of 21-30 years with male predominance. Patients in the division of medicine utilized most blood. Although the division of surgery requested most of the blood, on an average, they utilized only one-third of the requested product. Overall, anemia was the most common indication for red cell utilization. In surgical group, spine surgery had a maximum CT ratio. Neurosurgery and hand surgery had the lowest TI in all specialties. Hand surgery and spine surgery had a lowest transfusion probability. Overall, utilization rate in our study was 59.8%. A regular review of blood unit's usage is very important to estimate the blood utilization pattern in any hospital. Profile of blood utilization will act as indicator for quality management of blood bank.

Overview of transfusion reactions in patients with incompatible crossmatch at Sanglah General Hospital, Denpasar, Bali, Indonesia

Background: Transfusion reaction is a side effect of giving complete blood or one of the components. They vary in severity, ranging from reactions that can occur during a transfusion (acute transfusion reactions) or reactions occurring days to weeks later (delayed transfusion reactions) and can be immunological and non-immunological. This study investigated the description of transfusion reactions in patients who received blood with incompatible crossmatch results at Sanglah General Hospital
 Methods: This research is a descriptive study with a cross-sectional approach. Several parameters were assessed in this study to determine the transfusion reaction in patients who receive blood with incompatible crossmatch. Data were analyzed using SPSS version 20 for Windows.
 Results: In this study, from 72 patients who received incompatible blood, 75.0% were found for women and 25.0% for male patients, most of whom were aged 41-65 years (65.0%). Most blood type is blood type O (52.0%). In this study, 6 patients (8.3%) got transfusion reactions such as fever accompanied by chills, urticaria, hypotension, and shortness of breath.
 Conclusions: Incompatible crossmatch blood administration can be given. If a reaction is given to a crossmatch transfusion that is not suitable, symptomatic therapy can be given because the response provided is only acute and mild.

Efficiency of Blood Utilization in Elective Oncosurgeries in a Tertiary Care Cancer Centre: A Case for Data Disaggregation.

Oncosurgeries based on radical resection significantly increase the chances of intraoperative blood transfusion which leads to blood requisition based on subjective anticipation. Periodic audit and revisiting practice based on disaggregating data on the basis of surgical region could preserve blood, which is a scarce resource globally. This report proposes to use the results for reviewing the existing blood ordering schedule, in addition to proposing wider adoption in other cancer institutes using this report as a template. A retrospective analysis was performed for the entire patient cohort who underwent elective oncosurgeries between January 1, 2020, and January 31, 2021, and for whom blood reservation was done. Number of blood units cross matched and transfused for each patient for each surgery was noted. Efficiency of blood utilization was calculated using cross match transfusion ratio (CTR), transfusion probability (TP), and transfusion index (TI) indices and, finally, maximum surgical blood order schedule (MSBOS) was computed. Out of 718 elective oncosurgeries performed, blood requisition of 710 units was made for 345 procedures. Of the total units cross matched, only 76 units (10.70%) were transfused, leaving 89.29% units unutilized. Overall, CTR, TP, and TI were 9.34, 11.59%, and 0.22, respectively. Head and neck surgeries had the highest number of patients cross matched as well as units reserved, but not transfused. Conversely, abdominal surgeries had the highest transfusion probability. There is inefficient blood utilization in elective oncosurgeries and we recommend implementation of MSBOS based on anatomic region to improve efficiency of blood utilization.

The Use of the Electronic Cross-Matching in Transfusion Center

Purpose: To demonstrate the results obtained as an outcome of using electronic cross-match (ECM) procedure which shortens the last phase of the preparation of one or more blood product output only by checking the ABO compliance that the patient does not have an alloantibody in life and confirmed by antibody screening with in the last 72 hours through inquiring the database and might reduce the costs. Methods: The patients transfused in whom ABO compatibility of the blood and blood product was investigated using ECM procedure in the hospital between the years 2014 and 2015 were included in the study. The prerequisites stipulated by American Association of Blood Banks, and indicated in its 2003 guideline were provided. The blood-typing and indirect Coombs (IC) tests have been analyzed by gel colon agglutination system. Results: During the study period, 25989 units packed red blood cells (RBCs) and 16 units whole blood were ordered from the clinics, and reserved for them. But 11254 units RBCs and 15 units whole blood were used. Crossmatch transfusion rate would be 2,3 if serologic crossmatch was performed to all of the blood products instead of ECM in transfusion laboratory. The costs of both procedures differed 2.07 times. During two years incompatible or mismatched blood transfusion and acute hemolytic transfusion reaction were not observed. Conclusion: The most important problem that can be experienced in the absence of blood products is the loss of human life which is beyond the limits of cost calculation. For this reason, it is thought that the advantages of the ECM model cannot be measured. It is thought that it will be beneficial to spread the usage of ECM in transfusion center laboratories without compromising quality standards and blood transfusion safety.

Blood Transfusion Requests: An Audit in a Blood Transfusion Wing of a Referral Laboratory

Introduction: Transfusion of blood and its components such as Packed Red Cell (PRC), Platelet Rich Plasma (PRP) and Fresh Frozen Plasma (FFP) play an important role as a supportive therapy in patients admitted to a hospital.
 Objective: To conduct an audit of blood transfusion requests regarding demographic data of the recipients, the component therapy, blood groups of the issued units, cross-match transfusion ratio, expiry of the transfusion units, pattern of blood components usage and transfusion reaction for which blood was returned back to blood bank.
 Materials and Methods: This retrospective crosssectional study was conducted at the transfusion wing of a referral laboratory over a period of three months from January 2013 to March 2013 upon 3015 episodes of transfusion units of whole blood and different blood components.
 Results: Out of total 3015 episodes of transfusion unit in 1926 recipients, 930 were male and 996 female. About 41.0% requests of transfusion units received from the department of Obstetrics and Gynaecology (OBG) followed by the department of Surgery of about 28.7%. The most commonly used transfusion units was whole blood (55.3%) followed by platelet rich plasma (27.2%). Most of the recipients (62.3%) received single transfusion units and 37.7% recipients of ≥2 units. Out of 3769 cross-match, 3015 transfusion units were issued. In 12 (0.4%) cases, there were minor febrile and allergic reactions. During the study period, shelf life of six transfusion units had expired.
 Conclusion: This study suggests that either systems audit or medical practice audit of blood and blood component orders can help to reduce the inappropriate or indiscriminate transfusions and may be an important educational tool for the ordering physicians as well as for residents in training
 Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 3-6

\u201cIt\u2019s a precious gift, not to waste\u201d: is routine cross matching necessary in orthopedics surgery? Retrospective study of 699 patients in 9 different procedures

BackgroundOrthopedic surgeries are usually associated with excessive blood loss which leads surgeons to overestimate need for blood transfusions and over ordering of blood. The cross matched blood, when not used, leads to the wastage of blood bank resources in terms of time, money and manpower. The objective of this study was to investigate the compliance to previously proposed MSBOS and to provide updated recommendations for all orthopedic procedures.MethodsA retrospective analysis was conducted between 1st June 2015 and 31st May 2016. Patients admitted to the orthopedic surgery service for whom blood products were requested were included. Cross Match/Transfusion (CT) Ratio, Transfusion Index and Transfusion Probability were calculated. Values of < 2.5, > 0.5 and > 30% respectively, were taken as standards. Maximum Surgical Blood Ordering Schedule (MSBOS) was proposed based upon these calculations using Mead’s criteria.ResultsSix hundred and ninety-nine patients were sampled after implementing exclusion criteria. The overall CT ratio was 4.87, transfusion index was 0.55 and transfusion probability was 25%. A compliance rate of 24.6% was observed with the reference CT ratio of 2.5. Highest CT ratio was calculated for arthroscopic procedures while tumor resection had the lowest ratio. Age, procedure performed, ASA status and use of tourniquet were found to be significantly associated with CT ratio being greater or less than 2.5.ConclusionResults showed significant wastage of blood products and non-compliance with blood ordering guidelines. Hence there is need for large scale prospective studies to establish MSBOS and ensure its compliance.

A retrospective study of transfusion practice: Blood crossmatch ordering in obstetrics

Background: Parturient undergoing elective cesarian delivery (CD) in a busy tertiary care referral hospital often requires blood transfusions. The preoperative ordering for blood crossmatch frequently overshoots the actual need of transfusion. Aims: The primary aim of this study was to audit the local blood ordering practice in obstetric anesthesia and compare with the international guidelines. Materials and Methods: A retrospective analysis of patients who underwent elective CD over a period of 6 months was done. The data collected included patients' age, pretransfusion hemoglobin, timing of transfusion, number of units crossmatched, and number of units transfused. The crossmatch transfusion ratio (CTR), transfusion probability, and transfusion index were calculated from the data. Results: A total of 425 patients underwent CD with mean age 33 (standard deviation 7). Seventy-seven (18%) of them were crossmatched with total 252 units. Thirty-one (7.3%) patients required transfusion and the number of units transfused was 79. CTR in our study was 3.2. Conclusion: CTR for elective CD is higher than the recommended international quality indicator value. There is a need to develop institutional specific blood ordering schedule to bring improvement in transfusion practices.

Safety of uneventful cesarean section in terms of hemorrhage

Objective: Hemorrhage still continues to be reported as one of the leading causes of maternal mortality and morbidity. Intraoperative estimation of the blood loss seems to be complex and misleading as it is impaired by the amount of amniotic fluid and blood from the placenta. The present study was aimed to investigate the safety of intraoperative deciding on an uneventful cesarean section in a low risk patient population. Material and methods: One hundred patients free from hemorrhage risks and experienced an uneventful elective cesarean section, were included to the study. The decline in hemoglobin and hematocrit values, calculated blood loss, transfusion rate and presence of hemorrhage related symptoms and signs were accepted as the main outcomes of the study. Results: The average preoperative and postoperative hemoglobin values were detected as 12.09 ± 0.18 g/dl and 10.72 ± 1.39 g/dl, respectively. The average decrease in hemoglobin was 1.36 ± 1.06 g/dl. The observed decrease in hemoglobin values were less than 10% in 34.4% of the patients. The average blood loss was calculated to be 517.06 ± 417.55 ml. There were no patients with signs and symptoms of hemorrhage. Cross match transfusion ratio, transfusion probability and transfusion index was calculated as zero. Conclusion: The decision of uneventful cesarean section provides obstetricians a safe postoperative and postpartum period after following standardized surgical procedures in terms of hemorrhage and related complications.

Descriptive study of blood transfusion practices in women undergoing cesarean delivery

To study the blood transfusion practices in women undergoing cesarean delivery at a tertiary care centre in northern India. This was a prospective study conducted in 1769 women who underwent cesarean section at a tertiary centre hospital from May 2008 to November 2009. A comprehensive predesigned proforma was filled in for each woman. Data related to antenatal, intrapartum and postnatal events was recorded and compared between women receiving blood transfusion during cesarean section and women not receiving blood transfusion. The cesarean section rate was 26% and the blood transfusion rate was 12.21%. The overall crossmatch transfusion ratio in our study was 5.46:1. After multiple regression logistic analysis factors, like placenta previa (OR 15.19, 95% CI 9.28-24.82), anemia (OR 9.93, 95% CI 5.17-19.06), blood loss >1000 mL (OR 5.97, 95% CI 4.32-8.24), abruptio (OR 4.18, 95% CI 2.02-8.62), intraoperative complications, like uterine incision extension, uterine atony, hysterectomy (OR 2.69, 95% CI 1.70-4.24), general anesthesia (2.48, 95% CI 1.70-3.61) and inadequate antenatal supervision (OR 1.59, 95% CI 1.05-2.42) were found to be significantly associated with a higher risk for blood transfusion during cesarean section. Routine crossmatching of blood for all women prior to cesarean section needs to be reviewed. Cesarean sections performed on women with high risk factors for blood transfusion can have sudden and significant blood loss and thus adequate blood arrangement prior to cesarean section is justified only in this group of women and not in all women.

Detection of Cervical Lymph Nodes in Head and Neck Cancer: A Study of the Correlation Between Ultrasonic and Histological Findings in Wales

Detection of Cervical Lymph Nodes in Head and Neck Cancer: A Study of the Correlation Between Ultrasonic and Histological Findings in Wales

Audit of Blood Transfusion Services (BTS) in Total Knee Replacement (Tkr) And Total Hip Replacement (Thr) Surgery: A Prospective Study

Total knee and total hip arthroplasty surgery make up a significant proportion of elective orthopaedic surgery in our hospital. The blood transfusion services (BTS) are very important for the successful outcome of these surgeries. The present study was undertaken to monitor the Maximum Blood Order Schedule (MSBOS) and cross match transfusion ratio (C:T ratio) in 349 patients of TKR & THR in our hospital. Majority of the patients with pre-operative haemoglobin of more than 13 g/dL in both the categories (TKR and THR) did not receive any transfusion. C:T ratio of THR (1.3:1) was better compared to TKR (1.44:1). The MSBOS of 2 units of red cells for TKR is appropriate while for THR it should be 3 units of red cells for unilateral THR and 4 units of red cells for bilateral THR especially for patients with pre-operative haemoglobin less than 11 g/dL.

Audit on the Efficient Use of Cross-Matched Blood in Elective Total Hip and Total Knee Replacement

This prospective audit studies the use of cross-matched blood in 301 patients over a 1-year period undergoing total knee (TKR) and total hip replacement (THR) surgery in an orthopaedic unit. Analysis over the first 6 months revealed a high level of unnecessary cross-matched blood. The following interventions were introduced: (i) to cease routine cross-matching for THR; (ii) all patients to have a check full blood count on day 2 after surgery; and (iii) Hb < 8 g/dl to be considered as the trigger for transfusion in patients over 65 years and free from significant co-morbidity. These changes are in accordance with published national guidelines [Anon. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113: 24-31]. In the next 6 months, the number of units cross-matched but not transfused fell by 96% for THR, and the cross-match transfusion (C:T) ratio reduced from 3.21 to 1.62. Reductions were also observed for the TKR cohort. These results provide evidence of a substantial risk and cost benefit in the use of this limited resource. A telephone survey of 44 hospitals revealed that 20 hospitals routinely cross-matched blood for THR and 11 do so for TKR. Changes can be made to the Maximum Surgical Blood Ordering Schedules (MSBOS) in other orthopaedic units according to national guidelines.

BLOOD ORDERING FOR HAEMATEMESIS

The blood ordering practices for acute upper gastrointestinal bleeding were assessed in 162 consecutive patients presenting with haematemesis admitted via the Accident and Emergency Centre. The patients were classified according to their estimated blood loss and haemoglobin level at the time of admission, and the amounts of blood ordered and given in the next 24 h were determined. The crossmatch: transfusion (CT) ratio was very high in one group (14.9), although the overall ratio of 2.4 was acceptable. There were marked variations in the ordering pattern of different medical officers, possibly because of the absence of clear guidelines. From the data obtained, a set of guidelines for ordering blood in this clinical condition was developed. It was estimated that if these guidelines had been used, there would have been a reduction of one-third of all units crossmatched, and that the overall CT ratio would have been reduced to 1.6.

血小板同種抗体の検索と適合血小板輸血症例の臨床的検討

Three methods (lymphocyte cytotoxicity test: LCT, anti-human immunoglobulin lymphocyte cytotoxicity test: AHG-LCT, mixed passive haemagglutination test: MPHA) were used in detecting platelet alloantibodies in the sera of 89 patients received multiple platelet transfusions and employed the same three cross-match techniques to select compatible platelet donors for 13 patients (5 aplastic anemia, 6 acute leukemia, 2 chronic leukemia) who had become refractory to random platelet transfusion. In the sera of 89 patients, the frequency of positive sera by LCT, AHG-LCT and MPHA were each 42.7%, 55.1% and 36.0%. And 13 refractory patients received 116 platelet transfusions from HLA matched single donors. Of 116 transfusions, 9 incompatible by AHG-LCT cross-match alone had no increase of platelet count. The 24 hour-posttransfusion platelet increment more than 20000/mm3 was 76 (71.0%) in 107 compatible cross-match transfusions and 0 in 9 incompatible transfusions. The more HLA was matched, the more platelet count increased.