Supervisors info:
Νάστος Κωνσταντίνος, Αναπληρωτής Καθηγητής, Τμήμα Ιατρικής, ΕΚΠΑ
Πολίτου Μαριάννα, Καθηγήτρια, Τμήμα Ιατρικής, ΕΚΠΑ
Κοκόρη Στυλιανή, Αναπληρώτρια Καθηγήτρια, Τμήμα Ιατρικής, ΕΚΠΑ
Summary:
Maximum Surgical Blood Ordering Schedule (MSBOS) is a set of recommendations for determining the appropriate number of units of packed red blood cells which are cross-matched preoperatively per surgical procedure. The purpose of MSBOS is to optimize blood management. The idea of MSBOS creation emerged at the end of the 20th century in numerous health care centers. Parameters that are co-evaluated in MSBOS are the type of surgery, the patient's history and especially his bleeding profile and hemoglobin level preoperatively, the experience of the surgical team in each operation and each hospital's data on the blood needs in every operation. The first successful blood transfusion took place in 1667. However, the heyday of transfusion medicine came in the early 20th century with the discovery of the surface antigens of red blood cells. The establishment of blood banks and the development of blood separation techniques in the 1960s formed the basis of modern blood services. Nowadays numerous studies demonstrate the superiority of the "restrictive" transfusion strategy which is defined as the decision to transfuse at hemoglobin values of 7 or 8 g/dl. The aim of the above guidelines is the avoidance of unnecessary blood transfusions and thus their potential complications. Transfusion complications are divided into Immune (Acute hemolytic reaction, Febrile non-hemolytic reaction, Allergic or anaphylactic reaction, TRALI - Transfusion Related Acute Lung Injury) and Non-Immune Reactions (TACO - Transfusion Associated Circulatory Overload, Bacterial infection, Hyperkalemia, Iron overload). For that same reason, an attempt has been made to improve the bleeding profile of surgical patients preoperatively by correcting anemia, intraoperatively by using antifibrinolytic drugs and surgical techniques to reduce blood loss, and also postoperatively. Transfusion indices are used to determine the efficiency of blood ordering and blood use in surgical procedures. Their desirable values are C/T ratio ≤ 2.5, T% >30%, TI ≥ 0.5. The present retrospective study attempts to record the Greek reality at the General Hospital of Nikaia- Piraeus << St. Panteleimon >>, regarding the units of red blood cells that are requested, cross-matched and finally transfused intraoperatively by type of surgery. Data from January and September 2023 were recorded. A total of 629 units of packed red cells were requested, 492 units were cross-matched and 92 units were administered intraoperatively. Utilizing the transfusion ratios, the overall ratios’ results are 'C/T REQUESTED' = 6.84 and 'C/T' = 5.35. These ratios’ values are far from the desired 2.5. From this study’s results, it becomes apparent that with the exception of hernia repair operations, laparoscopic cholecystectomies, sleeve gastrectomies, mastectomies, appendectomies, tonsillectomies and arthroscopic operations - in which blood is properly not requested, in all the other operations studied, there is an excessive pre-operative over-ordering of blood units in our hospital. Similar practices are observed internationally mainly in less advanced healthcare systems rather than in the Western world. For that reason, it is deemed necessary to set up an MSBOS and a transfusion committee in our hospital that will ensure the compliance to MSBOS in clinical practice.
Keywords:
Maximum surgical blood ordering schedule, Blood units cross-match, Tranfusion indexes, Efficient blood utilization, Blood bank
