More effective blood transfusion policies in elective surgery by objective transfusion guidelines

: The blood ordering practice in a general hospital was evaluated for 22 types of frequently scheduled elective surgical procedures. The following parameters were used: the C/T ratio (crossmatched/transfused ratio) for appraising the tendency to over-order in terms of frequency, the BOQ (blood ordering quotient) to establish whether the appropriate amount is ordered, and the transfusion probability to establish whether the risk accompanying the procedure warrants crossmatching blood. Using the results a list was compiled grouping the procedures as follows: 1. transfusion probability greater than 30%: type & screen and crossmatching of blood before the surgical procedure; 2. transfusion probability less than 30%: type & screen; 3. transfusion probability = 0%: no type & screen (remaining procedures). The number of units crossmatched for surgical procedures in the first group is in accordance with actual expected needs. Owing to the use of this list of expected haemotherapy requirements the number of patients for whom blood is crossmatched preoperatively has diminished from 76.5% to 29.8%. Furthermore, the C/T ratio has decreased from 3.33 to 1.45 with a practically unchanged transfusion probability (the mean for 22 types of surgical procedures). The number of crossmatches for these procedures has shown a 56% decrease. The use of the list of expected requirements has led to an annual saving of Dfl. 20,000-on laboratory expenses.