“It’s a precious gift, not to waste”: is routine cross matching necessary in orthopedics surgery? Retrospective study of 699 patients in 9 different procedures

Abstract

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.

Blood transfusion practices in a tertiary care hospital in Nepal

“…11 A study conducted in Egypt in 2011 showed a similar overall CT ratio of 3.9 for a wide range of surgical procedures. 4 The mean C/T ratio is also lower than that reported from other studies from Benin (2.2), Nigeria (2.9), and Saudi Arabia (2.96). [12][13][14] A lower C/T ratio indicates better utilization of blood.…”

“…19 Other studies have also shown similar results with high C/T ratios but TI within the generally accepted range. 4 The current study is limited by its retrospective design and use of secondary data, which introduces errors like typing errors and missing records. We were unable to determine various other indices of blood utilization due to a lack of detailed records.…”

“…Establishing and adhering to a blood ordering protocol has been proven to reduce the financial burden to the patient, especially for elective surgical procedures. 4,35 Thus, formulating a blood ordering and transfusion protocol tailored to the hospital's needs, with input from all departments concerned, can reduce the non-usage of crossmatched blood units and thus optimize blood transfusion practices.…”

“…A ratio of 2.5 and below is generally considered indicative of significant blood usage. 4 A C/T ratio of more than 2.5 means that less than 40% of cross-matched blood is transfused, which indicates excessive cross-matching of blood for a specific procedure. [5][6][7] Transfusion index (TI) value of 0.5 or more is generally considered indicative of significant blood utilization.…”

“…[5][6][7] Transfusion index (TI) value of 0.5 or more is generally considered indicative of significant blood utilization. 4 In developing countries like Nepal, the provision of blood and blood products on time is a challenging task due to various factors such as lack of voluntary donors, lack of a robust healthcare network, and inadequate storage and transport facilities. Excessive ordering of blood products and low usage probability further exacerbates the problem.…”