Guideline for the Order of Anticipated Red Cell Uses Incorporating Preoperative Patient's Variables for Elective Surgery

Yi, Kyu Taeg; Kim, Duck An

Abstract

BACKGROUND: Most red blood cells that are crossmatched in a hospital blood bank are for surgical patients, and the majority of them is not transfused in spite of the use of MSBOS (maximum surgical blood order schedule). Because preoperative patients variables are omitted in MSBOS, an alternative system for ordering red cell units, which incorporates the patients variables for surgical patients, has been developed.
METHODS
We studied the average amount of transfused red blood cell units per each elective surgery and also calculated the average red blood cell volume reduction and average hemoglobin reduction for each elective surgery incorporating patients variables, such as preoperative hemoglobin, postoperative hemoglobin, weight during the period from January to December, 2001 in Hanyang university hospital. We compared transfused units with the anticipated units using MSBOS and the average red blood cell volume reduction and the average hemoglobin reduction. We evaluated factors associated with the risk of transfusion during surgery.
RESULTS
Total units transfused in elective surgeries were 2099 units. The anticipated units were 1925 in MSBOS, 1508 in average hemoglobin reduction, 1559 in average red blood cell volume reduction. With the exception of over-transfusion, the total transfused units were 953 units and the anticipated units were 1173 in the MSBOS, 1054 in the average hemoglobin reduction, and 1038 in the average red blood cell volume reduction. Factors associated with the risk of transfusion in multivariate regression analysis were preoperative hemoglobin (OR: 0.7431), sex (male=1, female=2, OR: 1.3166), weight (OR: 0.9890), age (OR: 1.0541), operating time (OR:1.0090).
CONCLUSIONS
Preoperative hemoglobin and weight are major factors associated with transfusions. Therefore, preoperative ordering for red cell incorporating these factors may be effective in reducing the unnecessary excessive cross matching and the workload in blood banks.