Probability Of Transfusion Research Articles

Utility of type and screen policy for pretransfusion compatibility testing at an urban level Ι apex trauma center

Objective: Type and crossmatch (TC) policy is the most common approach for pre-transfusion compatibility testing prior to issue of blood for transfusion. As it involves reserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can lead to excessive blood cross matching, inventory management problems, undue workload, blood outdating and reagent wastage. Type and screen (TS) policy is an alternative approach without the need to cross match and reserve blood units prior to issue. The aim of the current study was to retrospectively assess the impact of the implementation of TS policy for pre-transfusion compatibility testing on blood transfusion services at an urban level Ι trauma center. Methods: The study was done in two phases in the Department of Transfusion Medicine at Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data was collected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policy and second phase (Apr 2017-Sept 2017) of TS policy. Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusion probability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stock index (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentage of issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reduction in expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytic transfusion reaction was reported during the study. Conclusion: TS policy was found to be a safe and an efficient alternative approach to TC policy for pre-transfusion compatibility at our center. We recommend the implementation of TS policy, but each center should first assess its feasibility based on patient population, blood bank resources and staff knowledge.

Models to predict the probability for intraoperative RBC transfusion during lumbar spinal stenosis and femoral fracture surgeries in aged patients

ObjectiveThe goal of this study was to predict the probability of transfusion of red blood cells and the volume of blood consumption based on the clinical characteristics of patients before surgery. MethodsThe medical records of 565 patients over 65 years old who underwent posterior lumbar surgery and 586 patients over 65 years old receiving femoral fracture surgery were reviewed. The clinical characteristics of the patients were subjected to multivariate regression analysis. The scores of these factors' influences on intraoperative red blood cells infusion were based on the odds ratio of each multivariate risk factor. Non-linear regression was performed to predict the probability of intraoperative blood transfusion and the volume of blood used for patients with different scores. ResultsThe factors that significantly influenced blood use during lumbar spinal stenosis and femoral fracture surgery in aged patients(P < 0.05) included age, body mass index, abnormal coagulation function, preoperative hemoglobin, administration of antithrombotic drugs, multisegmental lesions of the lumbar spine, femoral shaft fracture, secondary lumbar surgery and the time from fracture to surgery exceeding 48 h. According to our risk scoring system, patients of posterior lumbar surgery scored 0–10 and patients of femoral fracture had a score of 0–12. More than 50 % of patients receiving an intraoperative red blood cells transfusion during surgery scored>1. ConclusionThe scoring system can be used as a predictive model for the probability of red blood cells transfusion and the blood volume in aged patients undergoing lumbar spinal stenosis and femoral fracture surgeries.

Development and Performance Evaluation of a Clinical Predictive Model to Estimate the Risk of Red Blood Cell Requirements in Brain Tumor Surgery.

The identification of factors associated with perioperative red blood cell (RBC) transfusion provides an opportunity to optimize the patient and surgical plan, and to guide perioperative crossmatch and RBC orders. We examined the association among potential bleeding risk factors and RBC requirements to develop a novel predictive model for RBC transfusion in patients undergoing brain tumor surgery. This retrospective study included 696 adults who underwent brain tumor surgery between 2008 and 2018. Multivariable logistic regression with backward stepwise selection for predictor selection was used during modeling. Model performance was evaluated using area under the receiver operating characteristic curve, and calibration was evaluated with Hosmer-Lemeshow goodness-of-fit χ 2 -estimate. Preoperative hemoglobin level was inversely associated with the probability of RBC transfusion (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.39-0.63; P <0.001). The need for RBC transfusion was also greater in patients who had a previous craniotomy (OR: 2.71; 95% CI: 1.32-5.57; P =0.007) and in those with larger brain tumor volume (OR: 1.01; 95% CI: 1.00-1.02; P =0.009). The relationship between number of planned craniotomy sites and RBC transfusion was not statistically significant (OR: 2.11; 95% CI: 0.61-7.32; P =0.238). A predictive model for RBC requirements was built using these 4 variables. The area under the receiver operating characteristic curve was 0.79 (95% CI: 0.70-0.87; P <0.001) showing acceptable calibration for predicting RBC transfusion requirements. RBC requirements in patients undergoing brain tumor surgery can be estimated with acceptable accuracy using a predictive model based on readily available preoperative clinical variables. This predictive model could help to optimize both individual patients and surgical plans, and to guide perioperative crossmatch orders.

A Review of Blood and Blood Products Requisition and Utilization in Post-neonatal Ward of a Tertiary Hospital in South Western Nigeria

Background: Blood and its products ordering is a common practice in paediatrics. The ready availability of blood and blood components has resulted in liberal use. Inappropriate use of blood and blood products exposes patients to the risk of transfusion transmissible diseases and allergic and haemolytic reactions.&#x0D; Objective: To assess blood and blood products requisition and utilization in a post-neonatal ward in a semi-urban tertiary hospital in Nigeria&#x0D; Methods: Retrospective analysis of medical records of all transfused post-neonatal patients during the study period from 1st July 2015 to¬ 31st December 2016 to calculate the cross-match to transfusion ratio, transfusion probability and transfusion index.&#x0D; Results: The units of blood cross-matched were 98 and 90 blood units transfused. The cross-match to transfusion ratio was 1.09 indicative of significant blood usage. The transfusion probability was 100% indicative of significant blood usage. The transfusion index was 1.10 indicative of significant blood utilization.&#x0D; Conclusion: Transfusion of blood and blood products in the post-neonatal ward of our setting meet the standard criteria for quality indicators for blood utilization.

Audit of Blood Utilization in a Tertiary Care Hospital

Context: Blood transfusion plays a vital role in saving lives. However, owing to its many side effects, it should be used judiciously. Aim: The aims of this study were: audit of blood utilization in our tertiary care set up, formulation of a maximum surgical blood ordering schedule (MSBOS) for procedures where a complete cross-match appears mandatory, and improvement in the efficiency of blood utilization in trauma care. Methods: All patients admitted to Lokmanya Tilak Municipal Medical College and General Hospital during the study period for whom cross-match requests were sent to blood bank were included in this study. They were divided into groups according to the departments under which they were admitted. Data were analyzed and cross-match to transfusion ratio (C/T ratio), transfusion index, and transfusion probability (%T) were calculated. C/T ratio was used as an index of the efficacy of blood ordering practice, and a ratio of &gt;2.5 was considered an indication of the excess cross match. Results: The maximum C/T ratio of 34.11 was noted in the Department of Cardiology. Only three departments (Artificial Kidney Dialysis, Pediatrics, and Medical Intensive Care Unit) showed effective utilization of blood. Minimum C/T ratio of 1.34 observed in the Department of Artificial Kidney Dialysis. Conclusion: We found gross over-ordering of blood by different departments. Hence we propose the formulation of a blood ordering schedule. We drafted a MSBOS which provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively, implementation of which will result in more efficient use of blood.

Audit of clinical use of blood products in a tertiary care hospital

Objectives: Blood and its components are an important part of patient management treatment protocols and like drugs have property to cause adverse reactions in the recipients. To maximize the effectiveness, safety and utility clinicians and intravenous therapists should be knowledgeable about the potential risk of blood component therapy. Hence, regular audit of blood and its component usage is essential to access the blood utilization pattern and set ideal policies in all the blood using specialties. Material and Methods: This is a prospective Study conducted in department of Transfusion Medicine at Vinayaka Mission Kirupananda Variyar Medical College &amp; Hospital for a period of one year. Source of data was blood bank requisition forms and blood bank registers of patients who underwent elective or emergency procedures in the hospital, for which blood was ordered. Results: The mean age of the study subjects was 41.8 years. The male : female ratio was 1.6 : 1. Majority of the study subjects were in the surgery department followed by Ortho and OBG. Majority of the study subjects belong to B+ve blood group followed by O+ve group and only 20% of the subjects belong to negative blood group. 70% of the subjects required blood transfusion for some kind of surgical intervention and only 28% had required blood transfusion related to medical causes. Majority required four units of PRC transfusion. Majority of the subjects had the haemoglobin levels in the range of 6–7 and the mean level was 6.56 gms%. Majority of the packed red cell was stored for 2 weeks or 5 weeks and the mean duration of storage was 4.3 weeks. A statistical significant improvement was observed in the mean haemoglobin levels in the post-transfusion period compared to the pre-transfusion haemoglobin. Only 5% of the times the reaction related to fever or anaphylaxis had occurred among the entire study subjects. 50% had completed the entire blood transfusion in less than 4 hrs and the mean duration was 4.3 hrs. 65.9% of the patients had appropriate blood transfusion based on the guideline and the remaining 34% had inappropriate blood transfusion. It is inferred from the table that the CTR, transfusion probability and the transfusion index was found to be above the guideline value to be considered as effective blood utilisation. Conclusion: Regular audit of blood components is crucial so that appropriate measures can be taken for proper usage. Continuous medical education regarding the transfusion services for the clinicians and staff nurses have major role in improvement for the clinical transfusion practices in the hospitals.

A Prospective Single Centre Study of Preoperative Blood Ordering Versus Actual Usage Among Patients Undergoing Elective Curative Oncological Resections in a Tertiary Care Hospital in India.

This study was a prospective, observational study aimed to look at the preoperative ordering schedule, pattern of usage of blood products for elective oncological surgeries in order to develop an institutional maximal surgical blood ordering schedule (MSBOS) in a tertiary university setting teaching Hospital. All biopsy proven, consenting, cancer patients of age 18 to 80years who underwent elective curative cancer surgery over a period of 1year were included. Various details such as nature of procedure, preoperative haemoglobin, intraoperative blood loss, duration of surgery, and number of units cross-matched and used were recorded and analysed. For each procedure, cross-match to transfusion (CT) ratio, transfusion index (TI), and transfusion probability (T%) were calculated using standard formulas. In all, 740 patients underwent elective curative cancer surgery in 1 year, majority being women and head and neck cancer being most common site. Overall, 312 patients received blood or component transfusion in the intraoperative and/or postoperative (within 48h) period constituting 42% of all patients, although 70% of patients had preserved packed cells and 55% had preserved fresh frozen plasma (FFP). Cross-matching of blood was adequate only in cases of liver surgeries, maxillectomy, staging laparotomy for ovarian carcinoma, and urological malignancies with a desirable CT ratio falling within 2.5. An institution specific-MSBOS was developed. The study found a significant over-ordering of blood products. By implementing MSBOS, one can plan the collection and stocking of blood products thereby saving money, labour, and time.

Prevalence and intervention of preoperative anemia in Chinese adults: A retrospective cross-sectional study based on national preoperative anemia database.

BackgroundPreoperative anemia is an important pillar of perioperative patient blood management. However, there was no literature comprehensively described the current situation of preoperative anemia in China.MethodsWe conducted a national retrospective cross-sectional study to assess the prevalence and intervention of preoperative anemia in Chinese adults. Data were from the National Preoperative Anemia Database based on hospital administration data from January 1, 2013 to December 31, 2018.FindingsA total of 797,002 patients were included for analysis. Overall, 27.57% (95% CI 27.47–27.67) of patients had preoperative anemia, which varied by gender, age, regions, and type of operation. Patients who were female, age over 60 years old, from South China, from provinces with lower per capita GDP, underwent operations on the lymphatic and hematopoietic system, with laboratory abnormalities were more likely to have a high risk of preoperative anemia. Among patients with preoperative anemia, 5.16% (95% CI 5.07–5.26) received red blood cell transfusion, 7.79% (95% CI 7.67–7.91) received anemia-related medications such as iron, erythropoietin, folic acid or vitamin B12, and 12.25% (95% CI 12.10–12.40) received anemia-related therapy (red blood cell transfusion or anemia-related medications) before operation. The probability of preoperative RBC transfusion decreased by 54.92% (OR 0.46, 95% CI 0.46–0.47) as each 10-g/L increase in preoperative hemoglobin. Patients with preoperative hemoglobin less than 130 g/L was associated with longer hospital stay and more hospital costs. Patients with severe preoperative anemia given iron preoperatively had lower intra/post-operative RBC transfusion rate, shorter length of stay and less hospitalization costs, but no similar correlation was found in patients with mild and moderate preoperative anemia and patients given erythropoietin preoperatively.InterpretationOur present study shows that preoperative anemia is currently a relatively prevalent problem that has not been fully appreciated in China. More researches will be required to optimize the treatment of preoperative anemia.FundingNational Natural Science Foundation of China and the Logistics Support Department of the Central Military Commission.

Rationalized preoperative management of hip and knee arthroplasty patients: A retrospective cohort study

BackgroundCurrent practices prioritize transfusion readiness over preoperative hemoglobin (Hgb) optimization in elective arthroplasty patients. We characterized the relationship between preoperative Hgb and perioperative transfusion among patients undergoing primary hip and knee replacement in order to identify a threshold Hgb at which the probability of transfusion is negligibly low. We then evaluated an alternative preoperative patient management algorithm using an evidence-guided threshold for pre-transfusion testing. MethodsWe performed a retrospective cohort study of adults undergoing elective primary hip or knee arthroplasty at two academic hospitals between 2010 and 2017. A subset of patients received either no treatment, iron supplementation, or erythropoietin preoperatively. Logistic regressions modelled the likelihood of transfusion, adjusted for baseline covariates. Receiver operating characteristic plots were generated to determine which Hgb threshold best predicted transfusion. Our results informed a quality-improvement initiative involving revised preoperative clinical pathway. ResultsWe included 13,113 patients. A 10 g/L lower Hgb corresponded to 2.81 (95%CI: 2.43–3.25; p < 0.001) and 2.34 (95%CI: 1.95–2.82; p < 0.001) times higher likelihood among hip and knee arthroplasty patients, respectively. A Hgb ≤115 g/L yielded negative predictive values of 98% and 99% for predicting transfusion in hip and knee patients, respectively. A subsequent quality-improvement initiative decreased unnecessary pretransfusion testing by 82%, and was associated with cost-savings. ConclusionsOur results demonstrate that, at our center, a preoperative Hgb ≤115 g/L distinguishes between joint arthroplasty patients who require transfusion from those who do not. Patient-guided pretransfusion testing may streamline joint arthroplasty program efficiency.

AB173. SOH21AS183. Audit on blood ordering requests in mastectomies: the need for a routine group and hold

Background: A group and hold (G&H) forms part of the pre-transfusion compatibility testing and is commonly requested in anticipation of a possible blood transfusion. Requests made in the context of elective procedures with a low transfusion probability, such as a mastectomy, are associated with added financial burden and increases workload in a health system. This audit aims to analyse the cost-benefit associated with the routine request for a preoperative G&H in patients undergoing mastectomies

Predictors for blood loss and transfusion frequency to guide blood saving programs in primary knee- and hip-arthroplasty

Endoprosthetic surgery can lead to relevant blood loss resulting in red blood cell (RBC) transfusions. This study aimed to identify risk factors for blood loss and RBC transfusion that enable the prediction of an individualized transfusion probability to guide preoperative RBC provision and blood saving programs. A retrospective analysis of patients who underwent primary hip or knee arthroplasty was performed. Risk factors for blood loss and transfusions were identified and transfusion probabilities computed. The number needed to treat (NNT) of a potential correction of preoperative anemia with iron substitution for the prevention of RBC transfusion was calculated. A total of 308 patients were included, of whom 12 (3.9%) received RBC transfusions. Factors influencing the maximum hemoglobin drop were the use of drain, tranexamic acid, duration of surgery, anticoagulation, BMI, ASA status and mechanical heart valves. In multivariate analysis, the use of a drain, low preoperative Hb and mechanical heart valves were predictors for RBC transfusions. The transfusion probability of patients with a hemoglobin of 9.0–10.0 g/dL, 10.0–11.0 g/dL, 11.0–12.0 g/dL and 12.0–13.0 g/dL was 100%, 33.3%, 10% and 5.6%, and the NNT 1.5, 4.3, 22.7 and 17.3, while it was 100%, 50%, 25% and 14.3% with a NNT of 2.0, 4.0, 9.3 and 7.0 in patients with a drain, respectively. Preoperative anemia and the insertion of drains are more predictive for RBC transfusions than the use of tranexamic acid. Based on this, a personalized transfusion probability can be computed, that may help to identify patients who could benefit from blood saving programs.

Blood Transfusion Practice in Operating Rooms in Nemazee Hospital in Southern Iran.

The requests for blood products in elective surgeries exceed actual use, leading to financial wastage and loss of shelf-life. In this study, we assessed the blood transfusion indices in elective surgeries performed in the operating rooms. In this cross-sectional study, from January to June 2017, a total of 970 adult patients who underwent elective surgeries in the operating rooms of Nemazee hospital, a general referral hospital in southern Iran, were investigated. Demographic, clinical, and laboratory data, such as hemoglobin (Hb), hematocrit (Hct), platelets, prothrombin time (PT), and partial thromboplastin time (PTT) were gathered from medical records. Blood utilization was evaluated using the following indices: cross-match to transfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI), and Maximum Surgical Blood Order Schedule (MSBOS). The overall C/T, T%, and TI ratios were 2.49, 46.6%, and 0.83 for all procedures, and the highest and lowest ratios pertained to the thoracic and cardiac surgeries, respectively. The C/T ratio was ≥2.5 for all surgical procedures except for cardiac surgeries. T% was <30 for thoracic and orthopedics surgeries and ≥30 for other surgical procedures. In all surgical procedures, TI was less than 0.5, except for cardiac surgeries. Also, the MSBOS was about 3 units for cardiac surgeries and ranged from 0.5 to 1 units in other surgeries. The results of this study showed a high quality blood transfusion practice in cardiac surgeries, possibly due to more focus on this critical ward. Assessing difficulties in the process of reservation, utilization, and preparation of standard protocols and policies are required to improve the blood utilization practice in operating rooms.

Maximum Surgical Blood Ordering Schedule for Cancer Surgeries

Background and Objectives: Although blood ordering is a common practice in surgical field, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence-based estimates. In the absence of an explicit maximum blood demand policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence-based estimates of average requirement in a particular surgery. Maximum surgical blood order schedule (MSBOS) is a criterion developed from institutional usage statistics providing a figure for the number of units to be crossmatched for any given surgical procedure. Aims and objectives of this study were to prepare and implement MSBOS, to increase blood availability to other medical patients and surgical patients. Promote efficient use of blood inventory, workforce, and consumables. This also helps to reduce unnecessary pre transfusion testing and cross match studies. Methodology: A retrospective analysis of various surgeries was done and then, a maximum surgical blood order schedule (MSBOS) was prepared and implemented and various parameters were analyzed in the largest tertiary cancer care hospital of Gujarat over a 2-year period. The goal was to study the blood ordering strategies in the hospital for surgical patients and evolve an MSBOS. The total units demanded and the corresponding units issued were studied for surgical patients. Thereafter, transfusion probability, transfusion index (TI), and ratio of units crossmatched to actual units transfused (C/T ratio) were calculated. Transfusion guidelines for all surgeries requiring transfusions were proposed and implemented. Results: Crossmatch to transfusion ratio improved from 9.54 to 3.68. Transfusion probability was down to 30.04 from 13.24 and TI increased to 0.31 from 0.179. P value by using Z test for all three parameters was &lt;0.05. Conclusions: Z-test calculation showed significant statistical improvement in the above three measures. The study also identified the common cases where “Type and Screen” (T and S) procedure could be introduced in cases where the transfusion probability was low. The implementation of this proposal will avoid over ordering of blood which is beneficial to the institute.

Justification of Blood Requisition

Background: The purpose of this study is to compile and review the blood utilization in various surgical departments in a tertiary care trauma center. To monitor and improve transfusion practices, analysis of effective usage of blood and its components is necessary. Methods: A retrospective cross-sectional study was done in the department of pathology in our center for a period of 6 months. Data from blood requisition forms, transfusion forms, and issue register were compiled and reviewed. The number of units requested cross-matched and transfused for every patient was collected. Statistical Analysis: The data were entered in SPSS version 20 and analyzed through the calculation of blood transfusion parameters: (i) cross-match to transfusion ratio (C/T), (ii) transfusion probability (T%), and (iii) transfusion index (TI). Results: 2724 units of blood was cross-matched and 2108 units of blood was transfused. The overall C/T ratio calculated was 1.29, TI was 0.77, and T% was 88.2%. All these figures are under the desirable range. Conclusion: The study concluded that though the trauma center in our hospital meets the parameters required for blood transfusion, yet the departments requiring blood should critically analyze the blood requisitions to minimize the blood bank load and cost.

Blood Loss and Related Laboratory Changes after Single-Event Multilevel Surgery and Hip Reconstructive Surgery in Patients with Cerebral Palsy.

BackgroudSingle-event multilevel surgery (SEMLS) and hip reconstructive surgery (HRS) often cause intraoperative bleeding, consequently increasing the probability of transfusion and postoperative laboratory changes. Therefore, it is important to assess risk factors to predict the amount of blood loss. This study aimed to evaluate blood loss, its influencing factors, and the related laboratory changes during SEMLS and HRS in patients with cerebral palsy (CP).MethodsWe retrospectively examined consecutive CP patients who underwent SEMLS and HRS. Surrogate markers of blood loss, including preoperative and postoperative hemoglobin (Hb), hematocrit, and changes in Hb concentration, were assessed. Albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine levels were also analyzed for related laboratory changes. Risk factors were analyzed using multiple regression and logistic regression models.ResultsThe overall cohort comprised 1,188 patients. Of them, 1,007 and 181 underwent SEMLS and HRS, respectively. Furthermore, 72 of 181 patients underwent a concomitant Dega osteotomy. The regression model showed that low preoperative Hb concentration (p < 0.001), high albumin level (p = 0.007), low body mass index (BMI) (p = 0.002), and bilateral HRS (p < 0.001) were significant risk factors of postoperative anemia. Valproate medication was associated with Hb drop, and the risk factors for Hb level < 8 g/dL on postoperative day 2 were bilateral HRS and Dega osteotomy in the HRS subgroup. In total, 21.6% had elevated AST levels on postoperative day 2, and bilateral HRS (p < 0.001), Gross Motor Function Classification System (GMFCS) level V (p = 0.041), Dega osteotomy (p < 0.001), and high preoperative AST level (p < 0.001) increased the risk of AST elevation.ConclusionsWe have summarized the estimated blood loss and related laboratory changes after SEMLS and HRS in patients with CP and identified the risk factors. Clinical guidelines should be accordingly developed to include assessment of these risk factors and their impact in the outcomes of CP patients undergoing SEMLS and HRS.

Pre-operative blood ordering – Choose wisely!!

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. 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. 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%). 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.

Blood Requests and Utilization in Elective Surgical Patients in a Nigerian Teaching Hospital

Abstract Introduction/Objective Although requesting for blood is a very common practice for patients for surgical interventions, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence based estimates. Over-ordering of blood components results in wasting of technical time, reagents and imposes extra cost on patients. The objective of this study is to assess blood ordering and utilization in a Nigerian Tertiary Hospital. Methods A review of one year data collected from the records of all discharged surgical patients and blood bank registers was done. Blood utilization was calculated using crossmatch to transfusion ratio (C/T), transfusion probability (%T), and transfusion index (TI). Results A crossmatch request for 1,228 units for 569 patients was made. Requests was higher for gynaecological cases (24.8 %) followed by orthopaedic procedures and least for cardiothoracic and urological surgeries (1.4 % each). Out of the crossmatched units, 880 units was transfused for 373 patients. The overall of C/T, %T, and TI were 1.4, 65.6%, and 1.55 respectively. The highest C/T was observed in elective caesarean sections (2.25) and neurosurgeries (2.2) while the lowest C/T was observed in oral maxillofacial surgeries (1.09) Conclusion Unnecessary crossmatching with minimal transfusion practice was observed in many elective surgical cases. Blood request pattern for elective surgeries needs to be revised and unnecessary requests minimized. There is a need for a Hospital blood transfusion committee which should come up with blood request policies and transfusion guidelines for elective surgical procedures and also conduct regular blood transfusion service audits.

Survey of Maximum Blood Ordering for Surgery (MSBOS) in elective general surgery, neurosurgery and orthopedic surgery at the Poursina Hospital in Rasht, Iran, 2017

IntroductionBlood is a valuable life resource that depends on the donation of blood by the community. As a result, it is crucial that the manner in which this expensive resource is used be correct and reasonable. ObjectiveThe purpose of this study was to investigate the Maximum Blood Ordering for Surgery (MSBOS) in general, orthopedic and neurosurgical elective surgeries at the Poursina Hospital in Rasht in 2017. MethodsAccording to the patient file number information, such as gender, age, type of surgery, number of blood units requested, number of cross-matched blood units, number of blood units transfusion, number of patients undergoing transfusion, number of patients who were cross-matched, initial hemoglobin and the underlying disease, was extracted from the HIS (Hospital Information System). Based on the collected data, a descriptive report of the cross-match to transfusion ratio (C/T), transfusion index (TI) and transfusion probability (%T) was performed, using average and standard deviation, by using the SPSS 16. ResultsIn the present study, 914 patients from the neurosurgery, orthopedic and general surgery wards of the Poursina Hospital were studied. Of these, 544 were male (59.5%) and 370 were female (40.5%), aged 1–99 years, with a mean age of 43 years. The frequency distribution of C/T in this study was 1.29 in neurosurgery, 1.95 in orthopedic surgery and 1.96 in general surgery.This study indicated that the C/T index was above the normal standard level in four different kinds of surgery, including leg fracture (2.71), cholecystectomy(2.71), forearm fracture (2.70), and skin graft (2.62).The C/T index was at the maximum normal level in thyroidectomy surgery (2.5). The other surgeries had the normal C/T index. ConclusionOverall, all of the MSBOS indices were at the standard level in this study, although C/T indices were higher than the standard level in the surgeries for cholecystectomy, leg fracture, forearm fracture, hand fracture and skin graft.

Surgical blood ordering schedule for better inventory management: An experience from a tertiary care transfusion center

BackgroundOverordering of blood has been a challenge faced by the blood bank staff. The present study addresses the role of maximum surgical blood ordering schedule (MSBOS) in optimizing the blood inventory management. MethodsThe blood requests for elective surgical procedures from various surgical departments were reviewed to constitute MSBOS. Transfusion profile was assessed using crossmatch to transfused units (C/T) ratio, transfusion probability (TP), and transfusion index (TI). A cutoff of 0.3 and 5% value of TI and TP, respectively, was considered to decide on the type of crossmatch. The efficacy of MSBOS implementation has been determined prospectively by unpaired t test using SPSS software, version 20 (IBM, USA). ResultsA total of 2674 patients were studied. Overall red cell usage rate was 15%. The comprehensive C/T ratio was 4.57. The C/T ratios for the various departments ranged from 1 to 8.5 (adjusted C/T ratio). Highest C/T ratio was observed for surgical procedures performed in the specialties of otorhinolaryngology and urology. A C/T ratio greater than 5 was noted in 30.4% of different types of surgical procedures. Of the 176 different types of elective surgical procedures studied, type and screen protocol was applicable for 75.5% (133) of the procedures. After implementation of MSBOS, the number of crossmatches reduced by 2152 and total working time saved in our laboratory is close to 75,320 man hours. ConclusionMSBOS helps in identifying the common surgical procedures with low TP and is one of the efficient tools in preventing the overordering of the blood.

Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: The Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool.

Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database, significant predictors for PLT transfusion were identified by multivariate logistic regression. Using a development data set containing 2005 to 2016 data, the Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool was developed by assigning weights to each significant predictor that corresponded to a probability of PLT transfusion. The predicted probability for each score was compared to actual PLT transfusion occurrence in a validation (2017) data set. The development data set contained 38 independent variables and 91 521 observations. The validation data set contained 12 529 observations. The optimal model contained 23 variables significant at P < .001 and an area under the receiver operating characteristic (ROC) curve of 0.69 (95% confidence interval [CI], 0.68-0.69). ACSePT contained nine variables and had an area under the ROC curve of 0.66 (95% CI, 0.65-0.66) and overall predicted probability of PLT transfusion of 19.8% for the validation data set compared to an observed risk of 20.3%. The ACSePT risk prediction tool is the first scoring system to predict a cardiac surgery patient's risk of receiving a PLT transfusion. It can be used to identify patients at higher risk of receiving PLT transfusions for inclusion in clinical trials and by PLT inventory managers to predict PLT demand.