An Analysis of Blood Utilization for Stem Cell Transplant Patients in a Tertiary Care Hospital

BACKGROUND AND OBJECTIVE: Haematopoietic stem cell transplant is a potentially curative treatment option in various benign and malignant haematological diseases. Patients undergoing stem cell transplant procedure require blood transfusion on a daily basis. Currently, there is paucity of data from developing countries on transfusion practices. This audit was undertaken to determine the consumption of packed red blood cells (PRBCs) transfusion in the bone marrow transplant unit of the Aga Khan University Hospital. SUBJECTS AND METHODS: A retrospective audit was conducted for packed red cell transfusion ordering practice over a period from June 2014~June 2015. All consecutive patients, admitted for stem cell transplant procedure for various underlying diseases were included. Outcome measures used in this study were (i) cross match to transfusion (C: T) ratio and (ii) transfusion trigger. RESULTS: During the study period, n=25 patients underwent haematopoietic stem cell transplant. There were n=19 males and n=6 females. One patient was less than 15 years of age while rests were adults. Median age±SD was 26.5±14.5 years (12~54 years). The underlying diagnosis included Aplastic anemia (n=8), Thalassemia major (n=3), Multiple Myeloma (n=4), Acute leukemia (n=5), Hodgkin’s lymphoma (n=4), PRCA (n=1). Grand total consumption of PRBCs during the study period was 204 while 258 products were crossmatch. The C:T ratio was 1.26. The transfusion trigger was Hb level of less than 8 gms/dl. CONCLUSION: The results of our BMT unit indicate that the C:T ratio and transfusion trigger is comparable to the international benchmark.

Analysis of Effectiveness of the Maximum Surgical Blood Order Schedule / 대한수혈학회지

BACKGROUND: The maximum surgical blood order schedule (MSBOS) is a viable option for reducing unnecessary crossmatching and achieving significant cost savings in the blood bank. In this study, we showed the process establishing MSBOS and through a prospective study, we evaluated the efficacy of MSBOS. METHODS: We organized task force team for transfusion management improvement composed of a director of the blood bank, surgeons and anesthesiologists in the Committee for Quality Improvement (CQI) of Asan Medical Center. In this team, we established MSBOS for most elective surgeries through the review of the previous transfusion and crossmatching data. We introduced MSBOS in April 1998 and prospectively analyzed surgeon's acceptance rate of MSBOS, crossmatch-to-transfusion ratio (C/T ratio), blood wastage rate, and cost savings. RESULTS: During the first 19 months after introducing MSBOS at our hospital, there was gradual increase in the surgeon's compliance rate of MSBOS from 30% to 94.0% through continuous education. The C/T ratio was changed from 3.5 to 1.6 and blood wastage rate was decreased from 4.0% to 1.9%. And also we could save more than 38,400,000 won through not performing the unnecessary crossmatches of 7,680 cases per year. CONCLUSION: Introduction of MSBOS can have a significant impact in reducing C/T ratio, blood wastage rate, and unnecessary crossmatches for the unused blood units. For successful application of MSBOS, cooperation with surgeons and anesthesiologists and continuous education is essential.

Optimal Blood Ordering for Solid Organ Transplantation / 대한수혈학회지

BACKGROUND: Currently brain dead solid organ transplantations are performed in several institutions, and these are extended in Korea. Especially liver transplantation requires such a large amounts of blood components including filtered and irradiated cellular components that blood bank should give a great support to provide them. For effective management and reducing workload of blood bank in solid organ transplantation, we evaluated the blood component usage according to the type of organ transplantation and suggest a guideline for its optimal blood ordering schedule. METHODS: From February 1995 to October 1997, 143 solid organ transplantations (18 adults and 7 pediatric liver transplants, 115 renal transplants and 3 heart transplants) were performed in Samsung Medical Center. We investigated amount of blood components requested by surgeons or anesthesiologists, and evaluated their usage, discard rate and C/T ratio (crossmatch to transfusion ratio) during perioperative, intraoperative and postoperative period for solid organ transplantation. In liver and heart transplantation, the usage of blood component according to the operative phases was also evaluated. RESULTS: All of the patients who underwent liver and heart transplantation and 15% of the patients who underwent renal transplantation were transfused with blood components during operation. For adult liver transplantation, 31.1 units of leukocyte-depleted red blood cells (LDRBC), 43.6 units of fresh frozen plasma (FFP) and 16.3 units of leukocyte depleted platelets (LDPC) on an average were transfused. Intraoperative salvage using Cell Saver was performed in liver transplantation and the volume of salvaged was 7127.6 mL which was equivalent to 28.5 units of RBCs. The C/T ratio of RBCs was 1.4. In pediatric liver transplantation, 4.8 units of LDRBC and 4.3 units of FFP were transfused with C/T ratio of 1.9. Two of 5 pediatric liver transplantation donors were transfused with 3 units of RBCs, 1.5 units of FFP and 1.0 unit of whole blood by preoperative autologous blood donation. Only 18 out of 115 patients who underwent renal transplantation were transfused with 2 units of RBCs and 2 units of FFP. The discard rate revealed over 60% and C/T ratio was 4.6-5.1 in renal transplantation. For the heart transplantation 1.3 units of RBCs, 5.6 units of FFP, and 7.3 units of LDPC were transfused. The C/T ratio was 3.8. CONCLUSION: Compared with foreign reports, slightly larger amount of blood components were used for liver transplantation, however similar amount were used for renal and heart transplantation. As the results of present study, we propose a guideline for optimal blood ordering schedule for solid organ transplantation considering the marginal safety : 40 units of LDRBC, 50 units of FFP, 20 units of LDPC and 8 units of Cryoprecipitate for adult liver transplantation; 5 units of LDRBC and 6 units of FFP for pediatric liver transplantation; 2 units of LDRBC, 6 units of FFP and 10 units of LDPC for heart transplantation. Additional requests of blood components for liver and heart transplantation might be decided considering the clinical situations.

Guideline for the Optimal Blood Ordering for Elective Surgery / 대한마취과학회지

In this study, the authors would like to establish the guideline for effective utilization of blood and blood components in various elective surgeries. We investigated the amount of tansfused blood and blood components units, C/T ratio (crossmatching to transfusion ratio), disused rate of blood ordered in 861 elective surgery cases during the period from October I990 to September 1991. overall mean units of transfusional units per patient were 5.3 units and overall C/T ratio was 1.14. Of all the transfusional units the ratio of whole blood was 51.5%, packed red blood cell was 7%, fresh frozen plasma was 41% respectively. From this study, the guideline for the optimal blood ordering for each elective surgery was made.

Clinical Evaluation of Effective Hemotherapy in Elective Surgery / 대한마취과학회지

For the purpose of effective utilization of donated blood with limited shelf life, the author investigated the transfusion data which were used for 778 patients who received 2,556 units of blood during the period from Jan. to Dec., 1988 in Pusan National University Hospital. The data were statistically studied and optimal guide line in elective surgery was established. The results were as follows. 1) In the period under study, transfusion ratio of each surgical department were from 37.6% to 83.6%. 2) Average CT ratio of elective surgical procedure was 1. 4 3) Number of crossmatched and transfused blood were about 4.7 units and 3.3 units by operating procedure in elective surgery, respectively. 4) The ratio of usage of blood component was 14.0%, and 120 of 778 transfused patients (15.4%) received a single unit transfusion. On the basis of these results and overviewed literature, it is summarized that established MSBOS & T & S order would be of value for decreasing in rate of outdating blood, overusage of blood, excessive crossmatching and laboratory costs.