Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr-Jun;13(2):329-335.
doi: 10.4103/ajns.AJNS_104_16.

Maximum Surgical Blood Order Schedule for Elective Neurosurgery in a University Teaching Hospital in Northern Thailand

Ananchanok Saringcarinkul  1 , Siriwan Chuasuwan  1
Affiliations

Maximum Surgical Blood Order Schedule for Elective Neurosurgery in a University Teaching Hospital in Northern Thailand

Ananchanok Saringcarinkul et al. Asian J Neurosurg. 2018 Apr-Jun.

Abstract

Context: Preoperative blood bank testing should optimize the trade-off between intraoperative transfusion delay and blood wastage.

Aims: This study aims to develop a maximal surgical blood order schedule (MSBOS) for elective neurosurgery.

Settings and design: Prospective data in University Teaching Hospital, Northern Thailand.

Subjects and methods: Blood transfusion data were collected on all adult patients satisfying inclusion/exclusion criteria in 2015. Patients were assigned to ten procedure groups (G): vascular: (1) Aneurysm/arteriovenous malformation, (2) Cerebrovascular bypass; tumor resection: (3) Meningioma, (4) Other, (5) Cerebellopontine angle, (6) Pituitary/craniopharyngioma, (7) Endoscopic pituitary; and miscellaneous: (8) Cranioplasty, (9) Spine, (10) Other. The crossmatch-transfusion ratio (C/T), transfusion probability (%T), and transfusion index (Ti) were calculated. MSBOS was generated by applying published criteria, subjected to clinical neurosurgical judgment.

Statistical analysis used: Statistical Package for the Social Sciences, Vision 20.

Results: Of 377 patients, 95% underwent preoperative cross-and-match (C and M) testing for 1422 red blood cell (RBC) units, while 3% had no type and screen (T and S) nor C and M, and 2% had T and S only. Overall C/T was 6.6, with range from 4 for G3-53 for G8. Intraoperative %T was 27%. Intraoperative Ti was 0.6. Our MSBOS recommended T and S only for G2, G7, G8, G9, G10; C and M of 2 RBC units for G1, G4, G5, G6; and C and M 2-to-4 for G3. If this were followed in 2015, intraoperative blood needs would have been satisfied for ≥82% of patients, and substantial reductions achieved in blood banking fees.

Conclusions: Our MSBOS may help optimize blood ordering and serve as an example for similar efforts for other surgical specialties.

Keywords: Blood transfusion; crossmatch-transfusion ratio; elective neurosurgery; maximal surgical blood order schedule; transfusion index; transfusion probability.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Algorithm for the development of maximal surgical blood order schedule. Rectangles left and center amalgamate various published criteria and cut-offs. Ovals center and right reflect empirical transfusion experience of the 2015 cohort and clinical neurosurgical judgment
Figure 2
Figure 2
Proportions of patients (y-axis) for whom specific numbers of preoperative cross-and-match red blood cell units (x-axis) would satisfy intraoperative transfusion needs, based on experience of the 2015 cohort of elective neurosurgical patients, by procedure group
Figure 3
Figure 3
Potential wastage costs of cross-and-match units reserved but not transfused intraoperatively in 2015 (solid blue), compared with maximal surgical blood order schedule applied to same cohort and transfusion rates (red crosshatch). cross-and-match cost US$3.46 each (Thai baht 120 at ฿34.72/$1.00)
See this image and copyright information in PMC

References

    1. Miller RD. Blood therapy. In: Miller RD, Pardo MC Jr, editors. Basics of Anesthesia. 6th ed. Philadelphia: Elsevier; 2011. pp. 373–80.
    1. Miller RD. Patient blood management: Transfusion therapy. In: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller's Anesthesia. 8th ed. Philadelphia: Elsevier; 2015. pp. 1830–67.
    1. Boral LI, Henry JB. The type and screen: A safe alternative and supplement in selected surgical procedures. Transfusion. 1977;17:163–8. - PubMed
    1. Sarma DP. Use of blood in elective surgery. JAMA. 1980;243:1536–8. - PubMed
    1. Friedman BA, Oberman HA, Chadwick AR, Kingdon KI. The maximum surgical blood order schedule and surgical blood use in the United States. Transfusion. 1976;16:380–7. - PubMed