Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, UK.
Transfus Med Hemother. 2013 Feb;40(1):27-31. doi: 10.1159/000345660. Epub 2013 Jan 3.
Preoperative over-ordering of blood is common and leads to the wastage of blood bank resources. The preoperative blood ordering and transfusion practices for common elective general surgical procedures were evaluated in our university hospital to formulate a maximum surgical blood order schedule (MSBOS) for those procedures where a cross-match appears necessary.
We evaluated blood ordering practices retrospectively in all elective general surgical procedures in our institution over a 6-month period. Cross-match-to-transfusion ratios (C:T) were calculated and compared to current trust and the British Society of Haematology (BSH) guidelines. The adjusted C:T ratio was also calculated and was defined as the C:T ratio when only cross-matched blood used intraoperatively was included in the calculation.
541 patients were identified during the 6-month period. There were 314 minor and 227 major surgeries carried out. 99.6% (n = 226) of the patients who underwent major surgery and 95.5% (n = 300) of the patients having minor surgery had at least a group and save (G and S) test preoperatively. A total of 507 units of blood were cross-matched and 238 units were used. The overall C:T ratio was therefore 2.1:1, which corresponds to a 46.9% red cell usage. There was considerable variation in the C:T ratio, depending on the type of surgery performed. The adjusted C:T ratio varied between 3.75 and 37.
Compliance with transfusion policies is poor and over-ordering of blood products commonplace. Implementation of the updated recommended MSBOS and introduction of G and S for eligible surgical procedures is a safe, effective and cost-effective method to prevent preoperative over-ordering of blood in elective general surgery. Savings of GBP 8,596.00 per annum are achievable with the incorporation of updated evidence-based guidelines in our university hospital.
术前过度配血很常见，导致血库资源浪费。我们评估了大学医院常见普通择期普外科手术的术前配血和输血实践，为那些需要交叉配血的手术制定了最大手术备血量表 (MSBOS)。
我们在 6 个月的时间内对我院所有择期普外科手术的配血实践进行了回顾性评估。计算了交叉配血与输血比（C:T），并与当前的信托和英国血液学学会 (BSH) 指南进行了比较。还计算了调整后的 C:T 比值，定义为仅包括术中使用的交叉配血血计算时的 C:T 比值。
在 6 个月期间，确定了 541 例患者。其中 314 例为小手术，227 例为大手术。99.6%（n=226）接受大手术的患者和 95.5%（n=300）接受小手术的患者在术前至少进行了组和保存（G 和 S）测试。共配血 507 单位，使用 238 单位。因此，总体 C:T 比值为 2.1:1，对应红细胞使用率为 46.9%。根据手术类型的不同，C:T 比值有很大差异。调整后的 C:T 比值在 3.75 至 37 之间变化。
输血政策的遵守情况不佳，血液制品过度订购很常见。实施更新后的推荐 MSBOS 并为符合条件的手术引入 G 和 S 是一种安全、有效且具有成本效益的方法，可以防止择期普外科手术术前过度配血。通过在我们的大学医院纳入最新的循证指南，每年可节省 8596.00 英镑。
