Blood Requisition and Utilization Practice in Surgical Patients in a Teaching Hospital, Western Nepal

Abstract

Background In surgical patients transfusion of blood is often a life-saving measure. Preoperative over-ordering of blood is very common and leads to holding up of the blood bank reserve and wastage of resources. Objective The main objective of this study was to evaluate the practice of cross-match and utilization of blood for general surgeries in a teaching hospital of Nepal, to identify the surgical procedures where type and screen can be introduced and to formulate a maximum surgical blood-order schedule for those procedures where a complete cross-match appears mandatory. Method Three hundred and eighty-eight patients of different general surgical procedures over a period of one year were evaluated. Blood units cross matched and units transfused intra-operative and post-operatively were recorded. Blood utilization was evaluated using the following indices: cross-matched to transfused ratio, transfusion probability and transfusion index. The maximum surgical blood-order schedule was calculated using Mead's criterion. Result Of the 601 blood units arranged for 388 patients, only 108 units were transfused in 81 patients. The cumulative non-utilisation of cross-matched blood was 82%. Based on these data, the maximum surgical blood-order schedule was calculated for seven common surgical procedures where cross-matching was justified. Conclusion Unwarranted cross-matching of blood is done in most procedures, especially cholecystectomies, hernia operations, breast surgeries, skin grafting, thyroidectomies etc. where a group and screen is adequate. Implementation of the recommended maximum surgical blood-order schedule and introduction of type and screen for eligible surgical procedures is a safe, effective and economic solution.