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An analysis of blood utilization for elective surgery in a tertiary medical centre in Malaysia.

BACKGROUND
The purpose of this study is to determine the efficiency of blood utilization for elective surgery at the University of Malaya Medical Centre (UMMC). A similar study conducted six years earlier in the same unit resulted in the introduction and implementation in December 1997 of the local Maximum Surgical Blood Order Schedule (MSBOS) and the Group Screen and Hold (GSH) procedure instead of a full crossmatch. This paper compares the findings of the current study with that conducted earlier.


MATERIALS AND METHODS
A prospective survey of the blood ordering practice for elective surgery over a 3-month period, from February to April 2001 was conducted in the Transfusion Medicine Unit (TMU) of the UMMC. Outcome measures used in this study were (a) decision on whether to perform a full cross match or a GSH procedure using the MSBOS guidelines, (b) the crossmatch transfusion ratio (CT), (c) the transfusion index (TI) and (d) the degree of over transfusion calculated from the pre and postoperative hemoglobin levels. The CT ratio and the TI were calculated for each type of elective surgery performed during the study period.


RESULTS
In the present study 31.2% of cases had blood crossmatched as against 40.6% in the earlier one The overall CT ratio was 5.0 and many procedures were found to have a high CT ratio and a low transfusion index. It was observed that 47.7% of patients were over transfused as compared to 45.5% in the earlier study.


CONCLUSION
The introduction of MSBOS and GSH has led to a significant decrease in the percentage (p= < 0.05) of cases for which a full crossmatch is done. The conservation policies have led to a decreased crossmatch workload and reduced blood outdating. Although the CT ratio has improved for many individual procedures, the overall CT ratio in fact increased from 4.4 to 5.0. There remains therefore, a continuous opportunity to improve transfusion practices by reviewing the local MSBOS. The transfusion index (TI) calculated for each procedure in this study can be utilized to recommend a GSH for those procedures with low TI.