An Update of Maximum Surgical Blood Order Schedule in Elective Surgery / 대한수혈학회지

BACKGROUND: Recently, operation technology and health care environment are continuously improving and changing. An updated MSBOS using current blood usage data is necessary for efficient blood management in the hospital blood bank. METHODS: This study was a retrospective analysis based on operation names according to the ICD-9-CM at Severance hospital in 2013. We calculated the average units of red blood cells according to each operation, as well as the total units of RBCs used per each operation and patient. Finally an average unit of RBCs was set for the MSBOS, which were ordered before surgical operation. These analyzed results were compared with the previous reports of our hospital and other hospitals. RESULTS: Transfusion episodes occurred in 3,092 cases, which is only 8.6% of all patients. Total transfused units were 8,230 units, 27% of total RBCs (2,270 units) transfused were used in cardiovascular surgery. Compared with the previous data, the usage of RBCs during surgery was decreased. CONCLUSION: The MSBOS investigated in this study showed some differences in the indicators in 2007. Therefore, regular update of the MSBOS is necessary in each hospital to reflect the advancement of surgical technology.

Applied the "Type and Screen" Method Based on Antibody Screening Test Including Di(a) Cells and Immediate Spin Crossmatch to All Patients Who Received Transfusion for Five Years / 대한수혈학회지

BACKGROUND: To prevent a hemolytic transfusion reaction caused by an unexpected antibody, a crossmatch following ABO/Rh typing and antibody screening test is performed before a red cell transfusion. The conventional crossmatch method is usually performed using the room temperature saline method, 37degrees C albumin method, and anti-globulin method. With growth and development of techniques for laboratory and records management, demand for reduction of work load is on the rise, therefore, use of the "type and screen" method and Immediate spin crossmatch as a pretransfusion test is recommended. METHODS: A retrospective analysis was performed using records from the Pusan National University Hospital blood bank from 2008 to 2012. Room temperature saline method omitting the anti-globulin crossmatch has been used in order to issue a compatible red cell product, when antibody screening performed using a cell panel (DiaCell I-II-Dia) in all patients where a request for a red cell transfusion was sent to the blood bank is negative, without previously identified unexpected antibodies. RESULTS: In total, 107,569 units of PRBCs were requested, 100,978 units (93.88%) were issued only immediate-spin crossmatch following type and screen method, and exclusion criteria were indicated in 6.12% of the total. There was no single case where the antibody screen was negative with guarantee of compatibility and hemolytic transfusion reaction occurred. CONCLUSION: The "Type and Screen" method based on antibody screening test including Dia cells and Immediate spin crossmatch application can contribute to safe, efficient transfusion service in the blood bank.

Change of the Disposal and the Cancellation Ratio after Enforcement of a Precedent Antibody Screening Test / 대한수혈학회지

BACKGROUND: In the clinical setting, for convenience of transfusion, blood is requested in advance, even though 'the type and screen' method has been used for the efficient supply of blood. We employed the precedent antibody screening test method for all patients who were scheduled for surgery, and compared the disposal rate and the clear rate pre and post-activity. METHODS: We evaluated the disposal rate and the cancellation ratio before and after employment of the precedent antibody screening test method for all patients expected to undergo surgery. A comparison of the frequency and type of side effects of transfusion was also performed. RESULTS: The disposal rate and the cancellation ratio showed a decrease, from 1.48% to 1.29%, and from 17.0% to 11.0%. No significant change was observed in the cause of disposal and the side effects of transfusion. CONCLUSION: Enforcement of a precedent antibody screening test resulted in a decrease in the disposal and clear rates. In addition, it aided in reduction of the amount of work performed at the blood bank by establishing the proper utilization of blood and reducing unnecessary cross match testing. There appears to be no problem regarding the stability of transfusion. However, for the sample showing a positive result on the antibody screening test, an effort to decrease the side effects of transfusion, such as exhaustive cross-matching and increasing the rate of identification, would be needed.

Change of the Disposal and the Cancellation Ratio after Enforcement of a Precedent Antibody Screening Test / 대한수혈학회지

BACKGROUND: In the clinical setting, for convenience of transfusion, blood is requested in advance, even though 'the type and screen' method has been used for the efficient supply of blood. We employed the precedent antibody screening test method for all patients who were scheduled for surgery, and compared the disposal rate and the clear rate pre and post-activity. METHODS: We evaluated the disposal rate and the cancellation ratio before and after employment of the precedent antibody screening test method for all patients expected to undergo surgery. A comparison of the frequency and type of side effects of transfusion was also performed. RESULTS: The disposal rate and the cancellation ratio showed a decrease, from 1.48% to 1.29%, and from 17.0% to 11.0%. No significant change was observed in the cause of disposal and the side effects of transfusion. CONCLUSION: Enforcement of a precedent antibody screening test resulted in a decrease in the disposal and clear rates. In addition, it aided in reduction of the amount of work performed at the blood bank by establishing the proper utilization of blood and reducing unnecessary cross match testing. There appears to be no problem regarding the stability of transfusion. However, for the sample showing a positive result on the antibody screening test, an effort to decrease the side effects of transfusion, such as exhaustive cross-matching and increasing the rate of identification, would be needed.

Pruebas de compatibilidad pretransfusional. Protocolo de compatibilidad mayor vs. tamizaje de AC irregulares y compatibilidad abreviada. ¿Cuál es óptimo para implementar en bancos de sangre? / Pretansfusional testing. Crossmatch vs type and screen. Wich is the better to implement in the blood banks?

Cualquier prueba pretransfusional tiene como objetivo garantizar la normal sobrevida de las células rojas transfundidas (detectando anticuerpos clínicamente significativos en el suero del receptor), minimizar los riesgos para el paciente y contener los costos. Desde su introducción, las pruebas pretransfusionales fueron sometidas a una constante modificación. La cuestión en debate es: ¿Qué constituye hoy, una estrategia segura y costo-efectiva y nos permite en forma rápida disponer de unidades compatibles?. La mayoría de los bancos de sangre testean en sus pruebas pretransfusionales: 1. grupo ABO y RH en dador y receptor. 2. Tamizaje de Ac irregulares en el receptor. 3. Identificación de la especificidad de ese anticuerpo irregular detectado. 4. Prueba de compatibilidad mayor (fase antiglobulínica) con una unidad Antígeno (Ag.) negativa. Bajo este protocolo una unidad compatibilizada es reservada para un paciente en particular por un tiempo de 48-72 horas (dependiendo de la política del servicio) y por lo tanto el stock de sangre disponible se verá reducido. En la política de tamizaje de ACS irregulares con compatibilidad abreviada (type and screen) , cada muestra de un potencial receptor es tipificada para ABO y RH y se realiza un tamizaje de AC inesperados pero clínicamente significativos. Para esto se incuba el suero del paciente con células conocidas (panel de 2 ó 3 tubos) que portan los Ag. de grupos sanguíneos más importantes y representativos, todos preferentemente en estado homocigota; se realiza una lectura a 37°C y una fase antiglobulínica. Si el resultado es negativo, no se reserva sangre compatibilizada. Si se requiere una transfusión, se realiza una compatibilidad abreviada (centrifugación inmediata) para demostrar incompatibilidad ABO y se libera la unidad. Si el resultado del tamizaje es positivo, se identifica el AC y se selecciona una unidad Antígeno negativa para realizar la compatibilidad mayor.

Pretransfusional tests have the object of assuring normal survival of transfused red cells (detecting clinically significant antibodies in the receptor serum), minimizing risks for patients and reducing costs. Since they were first introduced, pretransfusional tests have been subjected to continuous modifications. The issue under discussion is: Which protocol constitutes a safe and cost-effective strategy that allows for a quick availability of compatible units? In pre-transfusion tests, most blood banks test the following: 1. ABO group and RH factor in donor and receptor. 2. Sieving of irregular antibodies in receptor. 3. Identification of specificity of the detected irregular antibodies. 4. Crossmatching test (anti-globulin phase) with a negative Antigenic (Ag.) unit. Under this protocol. a compatible unit is kept for a particular patient for a 48-72-hour period (depending on the service policy) and therefore, the available blood stock will be reduced. In the policy for sieving irregular antibodies with abbreviated match (type and screen), each sample from a potential receptor is typified for ABO and RH, and a sieving of unexpected but clinically significant antibodies is carried out. For this purpose, the patients' serum is incubated with known cells (a 2 or 3-tube panel) which carry the Ag. of more relevant and representative blood groups, all of them preferably in homozygous state. Then an interpretation at 37° C and an anti-globulin phase are performed. If the result is negative, crossmatched blood is not stored. If a transfusion is required, an abbreviated crossmatch is carried out (immediate centrifugation) to demonstrate ABO incompatibility, and the unit is released. If the Sieving result is positive, the antibody is identified, and a negative antigen unit is selected to carry out the majar crossmatch.

Suggestion of Maximum Surgical Blood Order Schedule for Major Elective Surgeries in Korea / 대한수혈학회지

BACKGROUND: There have been many efforts to determine maximum surgical blood order schedule (MSBOS) of elective surgery in Korea since 1980?. But most of these data were confined to single hospital, so it was somewhat irrelevant to suggest them as general data in Korea. In this study, we tried to establish MSBOS which can be suggested as substantial and objective data in our country and to increase the efficiency of limited blood products. METHODS: From September 2003 to February 2004, we analyzed average RBC utilization for elective surgery in four university hospitals (Soonchunhyang University Hospital, Soonchunhyang University Bucheon Hospital, Korea University Ansan Hospital, Ajou University Hospital) by referring to anesthesiologic records and blood delivery sheets. Also, we established MSBOS range in operations performed more than five times in three among four hospitals. RESULTS: Sixty-seven operations were analyzed in our study and 18 of them were performed in department of general surgery. Type and screen (T&S) was recommended in 69.8~83.6% and the percentage of operations recommended as T&S in all four hospitals was 52.2%. Operations of obstetric/gynecology, urology and otorhinolaryngology were mostly applicable to T&S. CONCLUSION: We suggested comprehensive and substantial MSBOS range by analyzing the operations performed in four hospitals whose operation numbers ranged from 470 to 1,200 per month. It was considered that MSBOS range, which could be applicable to various hospitals, should be reestablished and enforced regularly to decrease medical cost and improve blood utility

Analysis of Surgical Blood Use and Determination of Maximum Surgical Blood Order Schedule at Dankook University Hospital / 대한수혈학회지

BACKGROUND: The aim of our study is to determine maximum surgical blood order schedule (MSBOS) in elective surgery through analyzing usage of blood products such as packed red cells and whole blood at Dankook University Hospital. We would like to establish the guidelines for effective utilization of blood products by introducing MSBOS to our hospital. METHODS: We calculated average amount of transfused blood for each elective surgery based on the discharge records of patients from January 1997 to December 1998 at Dankook University Hospital. Only those operations performed more than 5 times were included in this study. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For two years, the total number of surgery was 15,497 and the number of transfused operations was 1,682 (10.85%). Operation groups transfused below 10% was 77.3% of all 199 operation groups. The number of operation groups whose average of transfused blood was below 0.5 units was 80.3%. Type and screen (T&S) was recommended in 140 (70.4%) of all the operation groups. Of total groups MSBOS of 2 units was estimated in 4 groups (2.0%), of 3 in 14 groups (7.0%), 4 of 4 groups (2.0%), 5 of 2 groups (1.0%), 6 of 4 groups (2.0%), 7 of 7 groups (3.5%), and 8 in 2 groups (1.0%), respectively. CONCLUSION: We established MSBOS through the previous transfusion data of surgical operations over two years. To enforce MSBOS is needed for better medical services, which would decrease blood disuse and medical cost.