Perioperative transfusion analysis and blood ordering schedule update for total knee arthroplasty / 中国输血杂志

【Objective】 To investigate the perioperative rate of allogeneic red blood cell (RBC) transfusion in patients who underwent total knee arthroplasty (TKA) and its risk factors, and to identify its cross-match to transfusion ratio (C∶T ratio). 【Methods】 Anesthetic data of patients who underwent TKA from January 2014 to October 2019 in Peking Union Medical College Hospital were collected and analyzed retrospectively. Perioperative allogeneic RBC transfusion rate was calculated, and binary Logistic regression analysis was performed to identify its risk factors in these patients. The overall C∶T ratio was calculated and divided into subgroups based on surgery type and age group. 【Results】 The study enrolled 2 903 patients. The perioperative rate of allogeneic RBC transfusion in TKA patients was 10.9% (95% CI 9.8%~12.0%) and overall C∶T ratio was 5.6∶1. The independent risk factors leading to perioperative allogeneic RBC transfusion included advanced age(OR=1.025, 95% CI 1.009~1.042, P<0.01), preoperative hemoglobin level(OR=0.966, 95% CI 0.954~0.978, P<0.001), preoperative anemia(OR=3.543, 95% CI 2.052~6.119, P<0.001), hematological diseases(OR=6.462, 95% CI 2.479~16.841, P<0.001), bilateral surgery(OR=7.681, 95% CI 5.759~10.245, P<0.01) and revision surgery(OR=9.584, 95% CI 4.360~21.065, P<0.001). 【Conclusion】 The risk factors for perioperative allogeneic RBC transfusion in TKA patients included advanced age, preoperative low hemoglobin level, preoperative anemia, hematological diseases, bilateral surgery and revision surgery. Only type and screen tests are recommended if patients receiving unilateral primary TKA surgery are less than 75 years old without anemia and hematological diseases, while at least one to four units of blood should be cross-matched if patients are with preoperative anemia and hematological diseases or will receive bilateral and revision arthroplasty.

Establishment of the maximum surgical blood order schedule for cesarean sections / 中国输血杂志

【Objective】 To establish the catalog of maximum surgical blood order schedule(MSBOS) for cesarean sections with different obstetric complications, so as to guide the doctors of clinical and Blood Transfusion Department to prepare blood reasonably. 【Methods】 The blood transfusion data during cesarean sections from January to October 2021 in our hospital were collected via medical record information system and blood bank system.The blood recipients were classified according to the main obstetric complications. The incidence of blood transfusion, per capita RBC transfusion units, blood transfusion index (TI) and other indicators were calculated, the literature and the risk of massive hemorrhage were referred, and the actual situation of Obstetrics Department was considered to formulate the obstetric MSBOS of our own. 【Results】 1) The blood recipients during cesarean sections were mainly diagnosed as placental abruption, placental implantation, central placenta previa and severe preeclampsia; the incidence of blood transfusion of them was 17.9%(20/112), 17.7%(15/85), 16.8% (27/161)and 5.2%(9/173), respectively, and TI indexes was 0.9, 1.3, 1.0 and 0.3, respectively. 2) The MSBOS of Obstetrics Department in our hospital had been established, and the blood preparation for obstetric surgery was divided into three categories: T(blood typing)/S(antibody screening), T(blood typing)/S(antibody screening)/C(crossmatch) 2 U, and T/S/C 4 U. 【Conclusion】 The establishment of MSBOS in Obstetrics Department of our hospital provides references for preparing blood reasonably.

Analysis of cross matching to transfusion ratio of blood components in blood bank SKIMS, Soura: a prospective one year study

Background: Blood requisitions received in blood bank for elective and emergency procedures from surgery, trauma, Obstetrics and Gynaecology Department are often associated with excessive demand for cross matching of blood which is often more than the required blood and blood components. In this study, our goal was to use the blood stocks more efficiently and reduction in the wastage due to over dating and to prevent injudicious pre-operative cross-matching and utilization of blood.Methods: This was a prospective study conducted in the Department of Blood Transfusion and Immunohematology of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar over a period of one year with effect from September 2017 to August 2018. Source was requisition forms and blood bank records of patients who underwent elective procedures in the hospital. For the purpose of analysis, departments were categorized into surgical and allied branches i.e Cardiovascular Surgery (CVTS), Neurosurgery, General Surgery and Obstetrics and Gynaecology. Department wise utilization of blood Components cross matching to Transfusion ratio (C/T), transfusion probability (T%) and Transfusion Index (TI) were calculated. Data was entered and analyzed using Microsoft excel window 2010. The obtained data was evaluated and presented in the tabular and diagrammatic forms.Results: A total of 3940 requests for cross matching of blood and its components were received for 3072 patients. Out of these, 2048 units were transfused. The total C/T Ratio, Transfusion Probability (T%) and Transfusion Index (TI) was 1.92, 42.5% and 0.6 respectively.Conclusions: To reduce the injudicious usage of blood, blood transfusion services need to adopt blood conserving policies. Efforts should be made to adopt more conservative transfusion thresholds, periodic feedback to improve blood ordering, conduct regular auditing, handling, distribution and utilization practices of this scarce resource.

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.