ABSTRACT
Background@#Measurement of ABO isoagglutinin titers is important for patients who have received an ABO-incompatible organ transplant. Specifically, IgG isoagglutinin is essential for predicting graft outcomes in kidney transplantation, but many laboratories measure only the total isoagglutinin taking into consideration time and labor efficiency. In this study, we propose a useful method for predicting IgG isoagglutinin by analyzing the mathematical relationship between total and IgG isoagglutinin titers. Furthermore, the effects of patients’ characteristics of isoagglutinin were also analyzed. @*Methods@#From January 2017 to April 2022, the results of 3,676 total/IgG isoagglutinin titers of 65 patients who underwent liver and kidney transplantation were analyzed. Isoagglutinin titration was performed using the column agglutination technique with serially diluted serum samples and dithiothreitol was added for measuring IgG isoagglutinin. A generalized estimation equation (GEE) and the Deming regression were used to analyze the relationship and agreement of total/IgG isoagglutinin titers. @*Results@#In A, B, and O types, total isoagglutinin titers were 1.6 (2
ABSTRACT
Objective@#The aim of this retrospective study was to assess the midfacial soft tissue changes following maxillary expansion using micro-implantsupported maxillary skeletal expanders (MSEs) in young adults by cone-beam computerized tomography (CBCT) and to evaluate the correlations between hard and soft tissue changes after MSE usage. @*Methods@#Twenty patients (mean age, 22.4 years; range, 17.6–27.1) with maxillary transverse deficiency treated with MSEs were selected. Mean expansion amount was 6.5 mm. CBCT images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks. Statistical analyses were performed using paired t-test and Pearson’s correlation analysis on the basis of the normality of data. @*Results@#Average lateral movement of the cheek points was 1.35 mm (right) and 1.08 mm (left), and that of the alar curvature points was 1.03 mm (right) and 1.02 mm (left). Average forward displacement of the cheek points was 0.59 mm (right) and 0.44 mm (left), and that of the alar curvature points was 0.61 mm (right) and 0.77 mm (left) (p < 0.05). Anterior nasal spine (ANS), posterior nasal spine (PNS), and alveolar bone width showed significant increments (p < 0.05). Changes in the cheek and alar curvature points on both sides significantly correlated with hard tissue changes (p < 0.05). @*Conclusions@#Maxillary expansion using MSEs resulted in significant lateral and forward movements of the soft tissues of cheek and alar curvature points on both sides in young adults and correlated with the maxillary suture opening at the ANS and PNS.
ABSTRACT
Background@#In the author’s blood bank, if the Ab screening test results are positive in the pretransfusion test, an Ab identification test and polyspecific direct antiglobulin test (DAT) are performed. IgG and C3 monospecific DATs are also performed if the polyspecific DAT is positive. To perform additional tests, clinical technologists used to communicate with the clinical department by telephone, and then the clinical doctor issued the orders.There could be problems with this process, such as clerical errors and reduced work efficiency. Therefore, this study developed the secondary order program to improve the work efficiency of the blood bank. @*Methods@#The secondary order program that allows the laboratory medicine doctors to issue additional test orders, print out barcodes in blood bank, and immediately report the results to the EMR (Electronic Medical Record) was developed. Before (Jul 2018∼Jun 2019) and after (Jul 2019∼Jun 2020) applying the program to inpatients, the number of telephone calls, Ab screening tests, Ab identification tests, polyspecific DAT, and monospecific DAT were compared to evaluate the effectiveness of the program. @*Results@#After applying the program, 515 calls per year (average 43 calls per month) were reduced. Before the program, the results of 68 Ab screening tests and 16 polyspecific DATs were not reported on EMR, but no case was missed after the program. @*Conclusion@#Through the secondary order program, the work efficiency of the blood bank was improved. It is expected that expanding this program to other blood bank tests will help implement tests faster and make them more systematic.
ABSTRACT
Objective@#The aim of this retrospective study was to assess the midfacial soft tissue changes following maxillary expansion using micro-implantsupported maxillary skeletal expanders (MSEs) in young adults by cone-beam computerized tomography (CBCT) and to evaluate the correlations between hard and soft tissue changes after MSE usage. @*Methods@#Twenty patients (mean age, 22.4 years; range, 17.6–27.1) with maxillary transverse deficiency treated with MSEs were selected. Mean expansion amount was 6.5 mm. CBCT images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks. Statistical analyses were performed using paired t-test and Pearson’s correlation analysis on the basis of the normality of data. @*Results@#Average lateral movement of the cheek points was 1.35 mm (right) and 1.08 mm (left), and that of the alar curvature points was 1.03 mm (right) and 1.02 mm (left). Average forward displacement of the cheek points was 0.59 mm (right) and 0.44 mm (left), and that of the alar curvature points was 0.61 mm (right) and 0.77 mm (left) (p < 0.05). Anterior nasal spine (ANS), posterior nasal spine (PNS), and alveolar bone width showed significant increments (p < 0.05). Changes in the cheek and alar curvature points on both sides significantly correlated with hard tissue changes (p < 0.05). @*Conclusions@#Maxillary expansion using MSEs resulted in significant lateral and forward movements of the soft tissues of cheek and alar curvature points on both sides in young adults and correlated with the maxillary suture opening at the ANS and PNS.
ABSTRACT
Background@#In the author’s blood bank, if the Ab screening test results are positive in the pretransfusion test, an Ab identification test and polyspecific direct antiglobulin test (DAT) are performed. IgG and C3 monospecific DATs are also performed if the polyspecific DAT is positive. To perform additional tests, clinical technologists used to communicate with the clinical department by telephone, and then the clinical doctor issued the orders.There could be problems with this process, such as clerical errors and reduced work efficiency. Therefore, this study developed the secondary order program to improve the work efficiency of the blood bank. @*Methods@#The secondary order program that allows the laboratory medicine doctors to issue additional test orders, print out barcodes in blood bank, and immediately report the results to the EMR (Electronic Medical Record) was developed. Before (Jul 2018∼Jun 2019) and after (Jul 2019∼Jun 2020) applying the program to inpatients, the number of telephone calls, Ab screening tests, Ab identification tests, polyspecific DAT, and monospecific DAT were compared to evaluate the effectiveness of the program. @*Results@#After applying the program, 515 calls per year (average 43 calls per month) were reduced. Before the program, the results of 68 Ab screening tests and 16 polyspecific DATs were not reported on EMR, but no case was missed after the program. @*Conclusion@#Through the secondary order program, the work efficiency of the blood bank was improved. It is expected that expanding this program to other blood bank tests will help implement tests faster and make them more systematic.
ABSTRACT
There are limited data on the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory specimens after resolution of coronavirus disease 2019 (COVID-19)-associated symptoms/signs. We determined duration of SARS-CoV-2 virus shedding in symptomatic patients after remission of symptoms. We investigated the duration of SARS-CoV-2 RNA detection using real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 in nasopharyngeal/oropharyngeal swabs or sputum or saliva. Six patients were included in the final analysis. The median (range) duration of SARS-CoV-2 viral detection after hospitalization was 34 days (22 to 67). After resolution of symptoms/signs, SARS-CoV-2 RNA was detected for median (range) of 26 days (9 to 48). Among the six patients, one had persistent detection of SARS-CoV-2 RNA until day 67 of hospitalization, which was 30 days after symptom resolution. This case represents the longest duration of SARS-CoV-2 detection, and highlights the need for long-term follow up of COVID-19 patients despite resolution of symptoms to confirm SARS-CoV-2 clearance.
ABSTRACT
Background@#The current Korean Blood Inventory Monitoring System (BMS) has several drawbacks. It does not provide real-time data and only monitors 211 of the more than 2500 institutes that performed blood transfusions.This survey study investigated the status of BMS use and the preparation status of the data input system of medical institutions to help in the revision of BMS in preparation for the full surveillance of BMS. @*Methods@#A survey questionnaire was given to 200 hospitals participating in the current BMS, along with another set of questionnaires to 150 non-participating hospitals. The questionnaire consisted of the method of data registry to BMS, the current status of electronic medical records (EMR) and order communication system (OCS), perception, and readiness of adaptation of an open application programming interface system (API). @*Results@#Two hundred and one BMS participating hospitals responded to the survey. Approximately 75% entered data with a comma-separated value (CSV) or Excel spreadsheet (xls) files, and approximately half had an in-house developed EMR and OCS. The majority showed enthusiasm for the introduction to an open API. Among the non-participating hospitals, 138 responded. Approximately 70% counted the blood inventory daily, but approximately half did not use electronic methods for this process. The response to the introduction to an open API was positive, but the readiness for a prompt introduction was low at 15.9%. @*Conclusion@#These results will help revise the current BMS. On the other hand, full surveillance of BMS is anticipated to be hindered by the ready state of each medical institute. Moreover, the encouragement of participation would require supportive government administrative measures.
ABSTRACT
Background@#The current Korean Blood Inventory Monitoring System (BMS) has several drawbacks. It does not provide real-time data and only monitors 211 of the more than 2500 institutes that performed blood transfusions.This survey study investigated the status of BMS use and the preparation status of the data input system of medical institutions to help in the revision of BMS in preparation for the full surveillance of BMS. @*Methods@#A survey questionnaire was given to 200 hospitals participating in the current BMS, along with another set of questionnaires to 150 non-participating hospitals. The questionnaire consisted of the method of data registry to BMS, the current status of electronic medical records (EMR) and order communication system (OCS), perception, and readiness of adaptation of an open application programming interface system (API). @*Results@#Two hundred and one BMS participating hospitals responded to the survey. Approximately 75% entered data with a comma-separated value (CSV) or Excel spreadsheet (xls) files, and approximately half had an in-house developed EMR and OCS. The majority showed enthusiasm for the introduction to an open API. Among the non-participating hospitals, 138 responded. Approximately 70% counted the blood inventory daily, but approximately half did not use electronic methods for this process. The response to the introduction to an open API was positive, but the readiness for a prompt introduction was low at 15.9%. @*Conclusion@#These results will help revise the current BMS. On the other hand, full surveillance of BMS is anticipated to be hindered by the ready state of each medical institute. Moreover, the encouragement of participation would require supportive government administrative measures.
ABSTRACT
OBJECTIVE: The purpose of this study was to investigate the influence of heritability on the craniofacial soft tissue cephalometric characteristics of monozygotic (MZ) twins, dizygotic (DZ) twins, and their siblings (SIB). METHODS: The samples comprised Korean adult twins and their siblings (mean age, 39.8 years; MZ group, n = 36 pairs; DZ group, n = 13 pairs of the same gender; and SIB group, n = 26 pairs of the same gender). Thirty cephalometric variables were measured to characterize facial profile, facial height, soft-tissue thickness, and projection of nose and lip. Falconer's method was used to calculate heritability (low heritability, h2 0.9). After principal components analysis (PCA) was performed to extract the models, we calculated the intraclass correlation coefficient (ICC) value and heritability of each component. RESULTS: The MZ group exhibited higher ICC values for all cephalometric variables than DZ and SIB groups. Among cephalometric variables, the highest h2 (MZ-DZ) and h2 (MZ-SIB) values were observed for the nasolabial angle (NLA, 1.544 and 2.036), chin angle (1.342 and 1.112), soft tissue chin thickness (2.872 and 1.226), and upper lip thickness ratio (1.592 and 1.026). PCA derived eight components with 84.5% of a cumulative explanation. The components that exhibited higher values of h2 (MZ-DZ) and h2 (MZ-SIB) were PCA2, which includes facial convexity, NLA, and nose projection (1.026 and 0.972), and PCA7, which includes chin angle and soft tissue chin thickness (2.107 and 1.169). CONCLUSIONS: The nose and soft tissue chin were more influenced by genetic factors than other soft tissues.
Subject(s)
Adult , Humans , Chin , Lip , Methods , Nose , Passive Cutaneous Anaphylaxis , Siblings , Twins , Twins, Dizygotic , Twins, MonozygoticABSTRACT
Drug-induced immune hemolytic anemia is a rare disease that occurs in 1 in 1 million individuals of the general population. Rifampin-induced immune hemolytic anemia is caused by drug-dependent antibodies and this can be treated without complication by drug cessation. Herein, we present a case of rifampin-induced immune hemolytic anemia in a patient with primary Sjogren's syndrome (pSS) which occurred during treatment of pulmonary tuberculosis. At admission, the patient's laboratory tests revealed hemolytic anemia and positive direct antiglobulin test result. Since the incidence of autoimmune hemolytic anemia (AIHA) in pSS is reported to be 3 percent, which is higher than that of the general population, differential diagnosis between AIHA and rifampin-induced immune hemolytic anemia was required for planning future anti-tuberculous treatment. We identified rifampin-dependent antibody by drug-induced immune complex test and diagnosed rifampin-induced immune hemolytic anemia. Based on this experience, if rifampin administration is considered in patients with systemic autoimmune disease such as pSS, which has a high incidence of AIHA, we suggest evaluating the presence and the cause of hemolytic anemia at baseline by testing serum lactate dehydrogenase, haptoglobin, and direct and indirect antiglobulin tests before drug administration to promptly identify the cause of hemolysis if hemolytic anemia develops.
ABSTRACT
Lymphoplasmacytic lymphoma (LPL) is a low-grade B-cell neoplasm, composed of small B lymphocytes, plasmacytoid lymphocytes, and plasma cells, usually involving bone marrow and sometimes lymph nodes or spleen. LPL with bone marrow involvement and an IgM monoclonal gammopathy of any concentration is designated as Waldenström macroglobulinemia (WM). LPL associated with non-IgM monoclonal gammopathy or biclonal gammopathy is rarely observed. LPL diagnosis was based on clinical, morphological, and immunophenotypic findings. Recently, the test for L265P mutation of the myeloid differentiation factor 88 (MYD88) gene has been helpful in the diagnosis of LPL. Here, we reported the first case of LPL/WM with IgM-κ/IgA-λ biclonal gammopathy in Korea.
Subject(s)
B-Lymphocytes , Bone Marrow , Diagnosis , Immunoglobulin M , Korea , Lymph Nodes , Lymphocytes , Lymphoma , Multiple Myeloma , Myeloid Differentiation Factor 88 , Paraproteinemias , Plasma Cells , Spleen , Waldenstrom MacroglobulinemiaABSTRACT
BACKGROUND: Flow cytometry analysis of paroxysmal nocturnal hemoglobinuria (PNH) is significantly affected by the methodology used. The lack of data on the effect of age and refrigeration on PNH clone stability motivated us to study these aspects using flow cytometry. METHODS: Peripheral blood was collected from six patients, of which two presented with PNH. All samples were tested immediately and stored at room temperature (RT, 20–25℃) and at 4℃ for re-analysis at 24, 48, 72 hr and 7 days. Anti-CD59-fluorescein isothiocyanate (Beckman Coulter, USA) and anti-CD235a-phycoerythrin (PE; Beckman Coulter) were used to stain red blood cells (RBCs). Fluorescein-labeled proaerolysin (Cedarlane, Canada), anti-CD15-PE (Beckman Coulter), anti-CD24-PE-cyanin 5 (Beckman Coulter), and anti-CD45-PE-cyanin 7 (Beckman Coulter) were used to stain granulocytes. Flow cytometry was performed using a FC500 flow cytometer (Beckman Coulter). The effects of time and temperature were analyzed using generalized estimating equations. RESULTS: No significant differences in the gated percentage of RBCs and PNH clone size of RBCs were observed between the RT and 4℃ groups up to 7 days of testing. The percentage of gated neutrophils decreased with specimen age (P<0.001) and a better correlation with baseline was obtained at 4℃ than at RT (P=0.014). Neutrophil PNH clones were stable until 48 hr and 72 hr at RT and 4℃, respectively, and could not be analyzed at 7 days. CONCLUSIONS: RBC analysis was successfully performed up to 7 days. For neutrophils, testing within 48 hr is recommended, because the number of gated cells decreases significantly with age.
Subject(s)
Humans , Clone Cells , Erythrocytes , Flow Cytometry , Granulocytes , Hemoglobinuria, Paroxysmal , Neutrophils , RefrigerationABSTRACT
PURPOSE: This study was performed to analyze the clinical and imaging features of contemporary osteomyelitis (OM) and to investigate differences in these features on panoramic radiography according to patients' history of use of medication affecting bone metabolism.MATERIALS AND METHODS: The records of 364 patients (241 female and 123 male, average age 66.8±14.9 years) with OM were retrospectively reviewed. Panoramic imaging features were analyzed and compared between patients with medication-related OM (m-OM) and those with conventional, medication-unrelated OM (c-OM).RESULTS: The age of onset of OM tended to be high, with the largest number of patients experiencing onset in their 70s. The 2 most frequent presumed causes were antiresorptive medication use (44.2%) and odontogenic origin (34.6%). On panoramic radiographs, a mix of osteolysis and sclerosis was the most common lesion pattern observed (68.6%). Sequestrum, extraction socket, and periosteal new bone formation were found in 143 (42.1%), 79 (23.2%), and 24 (7.1%) cases, respectively. The m-OM group exhibited sequestrum and extraction socket more frequently and displayed significantly higher mandibular cortical index values than the c-OM group.CONCLUSION: We observed some differences in imaging features as shown on panoramic radiography according to the history of antiresorptive medication use. This study may help elucidate the predictive imaging features of medication-related osteonecrosis of the jaw.
Subject(s)
Female , Humans , Male , Age of Onset , Jaw , Metabolism , Osteogenesis , Osteolysis , Osteomyelitis , Osteonecrosis , Radiography, Panoramic , Retrospective Studies , SclerosisABSTRACT
BACKGROUND: Transfusion guidelines are not only essential for the optimal use of blood products, but also help reduce transfusion-related adverse reactions and improve patients' outcomes. In this hospital, a transfusion-indication data-entry program based on the national transfusion guidelines was developed and applied to the electronic medical record system in 2016. All transfusion orders, except for emergencies, have been performed using this program since then. This study analyzed the reasons for the transfusion to monitor the blood product usage and provide feedback to clinicians.
Subject(s)
Anemia , Electronic Health Records , Emergencies , Erythrocytes , Hemorrhage , Korea , Plasma , Plasma ExchangeABSTRACT
BACKGROUND: According to increased availability and awareness of automated blood bank analyzer with its speed and efficiency, use of automated analyzer in hospital blood bank has been increasing rapidly. We compared the ABO blood group typing results between automated analyzer IH-500 and manual method in healthy adults and patients with ABO discrepancies to provide useful information on interpretation of blood grouping results by automated analyzer. METHODS: Among healthy adults who underwent medical examinations, 400 samples (each 100 samples of A, B, O and AB type) were selected and evaluated the results and grades of blood grouping by automated and manual methods. Also, 50 samples showing ABO discrepancies among patients requested for pretransfusion test were selected and compared between two methods. As for samples with ABO discrepancies, further tests such as microscopic examination, reactivity with anti-A1 or ABO genotyping along with medical record review were performed. RESULTS: Agglutination results and grades in healthy adults were consistent between two methods. Meanwhile, 30 (60%) of ABO discrepant samples were related to rouleaux formation and their frequencies and agglutination grades were higher in automated method (Wilcoxon signed rank test, P=0.001). Results of discrepant samples caused by unexpected antibody or ABO subgroup showed no differences between two methods. CONCLUSION: IH-500 automated analyzer was considered useful for mass examination of healthy individuals. Meanwhile, considering the fact that ABO discrepancies by rouleaux formation were more frequent and stronger in automated method, it is recommended to retest their results by manual methods along with medical record review.
Subject(s)
Adult , Humans , Agglutination , Blood Banks , Blood Grouping and Crossmatching , Medical Records , MethodsABSTRACT
BACKGROUND: Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. METHODS: The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. RESULTS: Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. CONCLUSIONS: The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.
Subject(s)
Automation, Laboratory , Efficiency, Organizational/standards , Phlebotomy/statistics & numerical data , Republic of Korea , Time Factors , WorkflowABSTRACT
No abstract available.
Subject(s)
Female , Humans , Middle Aged , Base Sequence , Bone Marrow/pathology , DNA Mutational Analysis , Exons , Immunophenotyping , Leukemia, Mast-Cell/diagnosis , Mutation , Polymerase Chain Reaction , Proto-Oncogene Proteins c-kit/geneticsABSTRACT
BACKGROUND: Blood culture is a critical test for diagnosing bloodstream infections. Frequent microbial contamination during sampling and testing leads to abuse of antimicrobial agents. We evaluated methods for reducing contamination and obtaining more reliable results. METHODS: We analyzed blood cultures obtained between 2009 and 2015. We established 6 quality indicators: true positive rate, contamination rate, blood sampling volume, number of sets of blood cultures, delayed transportation rate, and percentage of samples collected from the femoral region, with reference to the CLSI guideline M47-A, 2007. Education was provided for interns and nurses responsible for blood sampling and transportation of specimens, and data were analyzed monthly. RESULTS: At baseline, the true positive rate was 12.8%, and the contamination rate was 4.0%. During the intervention period, these were decreased to 10.9% and 1.9%, respectively. The percentage of samples smaller than 5 mL decreased from 29.7% to 2.7-11.3%. The rate of one set of blood cultures being ordered was always <5%. The delayed transportation rate decreased from 35.6% to 5.5-7.7%. Finally, the percentage of samples collected from the femoral region decreased from 41.5% to 22.0-31.0%, because of which we did not attain our goal, 20.8%. CONCLUSION: The results showed improvements in contamination rate, specimen volume, specimen transportation time, and the percentage of samples collected from the femoral region. The quality management of blood cultures in 2011 was comparatively poor, which led to increased contamination rate, large number of samples containing <5 mL of blood, and increased percentage of samples collected from the femoral region. Thus, quality improvement methods can produce more reliable results of blood cultures.
Subject(s)
Anti-Infective Agents , Education , Femoral Artery , Femoral Vein , Quality Improvement , Quality Indicators, Health Care , TransportationABSTRACT
BACKGROUND: Most immune reactions related to transfusion and transplantation are caused by IgM ABO antibodies. However, IgG also plays an important role in these reactions. Therefore, a method to measure antibodies, including IgG, is necessary. We investigated ABO antibody titers of healthy individuals using a column agglutination technique (CAT) with or without dithiothreitol (DTT) and compared them with titers obtained using a conventional tube method. METHODS: Among healthy adults who underwent a medical examination, 180 individuals (60 with blood group A, 60 with group B, and 60 with group O) were selected. Antibody titrations were performed using the immediate spin (IS) tube, anti-human globulin (AHG) tube, and CAT with or without DTT methods. RESULTS: Higher median values of anti-B and anti-A titers in groups A and B individuals, respectively, were obtained using the IS method than using the AHG method. Higher values for group O individuals were obtained using the AHG method. Higher median titers of anti-B and anti-A in group O individuals were obtained using CAT without DTT than using the AHG method. Median titers of anti-B and anti-A in all blood groups were higher in CAT without DTT than in CAT with DTT, especially for group O individuals. CONCLUSIONS: We recommend CAT with and without DTT for titration of anti-A and anti-B, especially in group O individuals, to provide more sensitive results that include IgG data. Adjustment of insurance coverage of fees associated with antibody titration might be necessary, considering the actual cost of reagents and personnel.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , ABO Blood-Group System/immunology , Agglutination Tests/instrumentation , Antibodies/analysis , Immunoglobulin G/immunologyABSTRACT
BACKGROUND: The Soonchunhyang University Hospital Bloodless Center was established in 2000, and more than 2,000 bloodless surgeries have been performed there since. In this study, the lowest postoperative Hb/preoperative Hb (Hblow/pre) ratio and mortality rates of patients who underwent bloodless surgery were analyzed for each maximum surgical blood order schedule (MSBOS) category to assess whether MSBOS can be used as a predictor of successful completion of bloodless surgery. METHODS: A total of 971 patients were included. MSBOS was defined as the average number of units of RBCs transfused during each elective surgery. We used the Hblow/pre ratio as an alternative to intraoperative blood loss. Frequency of Hblow/pre ratios < or =0.5, use of transfusion alternatives, and mortality rates were compared across MSBOS categories. RESULTS: Out of the 971 patients, 701 (72.2%) were categorized as type and screen (T&S), 184 (18.9%) as MSBOS 1, 64 (6.6%) as MSBOS 2, and 22 (2.3%) as MSBOS 4. Transfusion alternatives were used by 397 (40.9%) patients. The frequency of the use of simultaneous erythropoietin and iron, hemostatics, acute normovolemic hemodilution, and Cell Saver (Haemonetics corp., USA) was higher in patients in the higher MSBOS categories. Six (0.6%) patients died within 30 days of surgery. Hblow/pre ratios tended to be lower as the level of MSBOS category increased. CONCLUSIONS: Surgeries in the higher MSBOS categories tended to be associated with high blood loss and mortality. Active use of transfusion alternatives is recommended in patients in high MSBOS categories who are scheduled to undergo bloodless surgery.