Subramanian Arulselvi, Sagar Sushma, Kumar Subodh, Agrawal Deepak, Albert Venencia, Misra Mahesh Chandra
Blood Bank and Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India.
J Emerg Trauma Shock. 2012 Oct;5(4):321-7. doi: 10.4103/0974-2700.102391.
Over ordering of blood is a common practice in elective surgical practice. Considerable time and effort is spent on cross-matching for each patient undergoing a surgical procedure.
The aim of this study was to compile and review the blood utilization for two key departments (Neurosurgery and Surgery) in a level 1 trauma center. A secondary objective was to formulate a rational blood ordering practice for elective procedures for these departments.
Analysis of prospectively compiled blood bank records of the patients undergoing elective surgical, neurosurgical procedures was carried out between April 2007 and March 2009. Indices such as the cross-matched/transfused ratio (C/T ratio), transfusion index and transfusion probability were calculated. The number of red cell units required for each procedure was calculated using the equation proposed by Nuttall et al, using preoperative hemoglobin and postoperative hemoglobin for each elective surgical procedure.
There were 252 surgery patients (age range: 2-80 years) in the study. One thousand and eighty-eight units of blood were cross-matched, 432 were transfused (CT ratio 2.5). 44.0% patients did not require transfusion during entire hospital stay. Three (50%) elective procedures had CT ratio >2.5and 4 (66.6%) elective procedures had TI <0.5. There were 200 neurosurgery patients (age range: 2-62 years) in the study. Total 717 units of blood were cross-matched and 161 transfused (CT ratio 4.5). Nine elective procedures had CT ratio >2.5, with five of them exceeding 4. In procedures like spinal instrumentation the CT ratio was <2.5 and 10 (90.9%) of elective procedures had TI <0.5.
In this study 40% and 22% of cross-matched blood was being utilized for elective general surgery and neurosurgical procedures, respectively. The calculated required blood units for all elective Trauma surgery procedures were more than 2 units. The calculated required blood units were less than 0.5 units in four of the 11 neurosurgical procedures, and hence only one unit should be arranged for them. It is crucial for every institutional blood bank to formulate a blood ordering schedule. Regular auditing and periodic feedbacks are also vital to improve the blood utilization practices.
在择期手术中，过度开具血液检查单是一种常见现象。为每个接受外科手术的患者进行交叉配血会耗费大量时间和精力。
本研究旨在汇总并审查一家一级创伤中心两个关键科室（神经外科和外科）的用血情况。次要目标是为这些科室的择期手术制定合理的血液开具检查单做法。
对2007年4月至2009年3月期间接受择期外科手术、神经外科手术患者的前瞻性汇总血库记录进行分析。计算交叉配血/输血比例（C/T比例）、输血指数和输血概率等指标。使用纳托尔等人提出的公式，根据每个择期外科手术的术前血红蛋白和术后血红蛋白计算每个手术所需的红细胞单位数。
本研究中有252例外科手术患者（年龄范围：2至80岁）。共交叉配血1088单位，输血432单位（C/T比例为2.5）。44.0%的患者在整个住院期间无需输血。3例（50%）择期手术的C/T比例>2.5，4例（66.6%）择期手术的输血指数<0.5。本研究中有200例神经外科患者（年龄范围：2至62岁）。共交叉配血717单位，输血161单位（C/T比例为4.5）。9例择期手术的C/T比例>2.5，其中5例超过4。在诸如脊柱内固定等手术中，C/T比例<2.5，10例（90.9%）择期手术的输血指数<0.5。
在本研究中，分别有40%和22%的交叉配血用于择期普通外科手术和神经外科手术。所有择期创伤外科手术计算所需的血液单位数超过2单位。11例神经外科手术中有4例计算所需的血液单位数少于0.5单位，因此应为其仅安排1单位血液。每个机构血库制定血液开具检查单时间表至关重要。定期审计和定期反馈对于改善用血做法也至关重要。
