|Year : 2021 | Volume
| Issue : 1 | Page : 89-91
Justification of blood requisition: A review in a tertiary care trauma center in Eastern India
Nitika Kesarwani1, Shalini Bahadur2, Saurabh Mahajan3, Anand Kumar4
1 Assistant Professor, Department of Pathology, ACS Medical College, Chennai, Tamil Nadu, India
2 Associate Professor, Department of Pathology, GIMS, Greater Noida, Uttar Pradesh, India
3 Final Year Resident MCH Department of Neurosurgery, Stanley Medical College, Chennai, Tamil Nadu, India
4 Professor,Department of Surgery, Banaras Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
|Date of Submission||11-Feb-2021|
|Date of Decision||20-Feb-2021|
|Date of Acceptance||06-Apr-2021|
|Date of Web Publication||29-May-2021|
Dr. Nitika Kesarwani
Assistant Professor, Department of Pathology, ACS Medical College, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: The purpose of this study is to compile and review the blood utilization in various surgical departments in a tertiary care trauma center. To monitor and improve transfusion practices, analysis of effective usage of blood and its components is necessary. Methods: A retrospective cross-sectional study was done in the department of pathology in our center for a period of 6 months. Data from blood requisition forms, transfusion forms, and issue register were compiled and reviewed. The number of units requested cross-matched and transfused for every patient was collected. Statistical Analysis: The data were entered in SPSS version 20 and analyzed through the calculation of blood transfusion parameters: (i) cross-match to transfusion ratio (C/T), (ii) transfusion probability (T%), and (iii) transfusion index (TI). Results: 2724 units of blood was cross-matched and 2108 units of blood was transfused. The overall C/T ratio calculated was 1.29, TI was 0.77, and T% was 88.2%. All these figures are under the desirable range. Conclusion: The study concluded that though the trauma center in our hospital meets the parameters required for blood transfusion, yet the departments requiring blood should critically analyze the blood requisitions to minimize the blood bank load and cost.
Keywords: Cross-matched, transfusion index, transfusion probability
|How to cite this article:|
Kesarwani N, Bahadur S, Mahajan S, Kumar A. Justification of blood requisition: A review in a tertiary care trauma center in Eastern India. Glob J Transfus Med 2021;6:89-91
|How to cite this URL:|
Kesarwani N, Bahadur S, Mahajan S, Kumar A. Justification of blood requisition: A review in a tertiary care trauma center in Eastern India. Glob J Transfus Med [serial online] 2021 [cited 2021 Dec 7];6:89-91. Available from: https://www.gjtmonline.com/text.asp?2021/6/1/89/317180
| Introduction|| |
Ordering of blood is a common practice in elective and emergency surgical procedures as blood transfusion has saved many for its major role in resuscitation and management of surgical patients. Over-ordering of blood much in excess of actual need results in increase demand of blood and its products. Increase in incidence of trauma and cancer has also led to a much need of blood and its products.
Over-ordering has become a common practice by surgeons as it is difficult to anticipate the easy accessibility of blood when it is needed. Problems in blood bank inventory management, excess expenditure of commercial reagent, and unnecessary laboratory work have mainly risen due to the practice of over-ordering. Around the world, in many countries, numerous studies have shown over-ordering of blood by surgeons with utilization ranging from 5% to 40%., India, Kuwait, and Nigeria have shown utilization rates of 28%, 13.6%, 69.7% respectively. In trauma patients, the utilization is less than 50%.
Search of literature reports that only 30% of cross-matched blood is used in elective surgeries, so our main concern is to use blood and its products appropriately in clinical practice. Transfusion department should frame and follow policies which can help in efficient management of blood bank. Type and screen policy is one of them in which patient's blood group is done, and the serum is screened for red blood cell (RBC) allo-antibodies. Units are not cross-matched unless and until there is actual transfusion required.
A blood ordering schedule should be developed by the evaluation of blood requisition and transfusion practices to serve as a guide for normal blood usage in elective and emergency surgical procedures for the effective usage of blood. This study was carried out with the purpose to review blood utilization in various surgical departments (orthopedics, neurosurgery, general surgery, emergency, and plastic surgery) in a tertiary care trauma center. The aim of this study was to evaluate and assess the efficiency of blood requisition and transfusion practices in our center.
| Materials and Methods|| |
A retrospective, cross-sectional analysis of blood bank records and blood requisition forms was done. The study of blood requisitions and transfusions performed in various departments of trauma center was compiled and reviewed over a period of 6 months from April 2015 to October 2015.
For each patient, the number of units requested, cross-matched, and transfused along with the number of patients cross-matched and transfused was collected and tabulated.
The data were entered in SPSS version 20 IBM SPSS Statistics for windows, IBM Corporation, Armonk, NY, USA and analyzed through the calculation of blood transfusion parameters: (i) cross-match to transfusion ratio (C/T), (ii) transfusion probability (T%), and (iii) transfusion index (TI).
The use of C/T ratio is an indicator of efficient blood usage. Ideally, this ratio should be 1.0, but a value below 2.5 was also considered effective.
The T% is calculated as:
A value of 50% and above has been considered as appropriate.
TI signifies the appropriateness of number of units cross-matched. A value of 0.5 or more is indicative of efficient blood usage.
The study has been ethically approved by the Institutional Ethics Committee, and the patient identity was maintained confidential by data coding.
| Results|| |
During the study period, 2724 units of blood was cross-matched for 1000 patients and 2108 units of blood was transfused. Only 77% of blood was utilized while 33% was not required though requested. [Table 1] reflects the number of patients, number of units cross-matched, and number of units transfused in various departments. [Table 1] also shows the various indices studied. Analysis of blood transfusion in patients following admission is also tabulated in [Table 2].
The maximum blood transfusion in patients within 24 h of admission and requisition was done in the department of general surgery (82.93%), followed by emergency unit (63.16%) and neurosurgery (48.83%). The departments of plastic surgery and orthopedics had maximum utilization beyond 48 h in spite of urgent requisition.
| Discussion|| |
Major role in the resuscitation and management of surgical patients is by blood transfusion, but ordering of blood is mostly based on subjective anticipation of blood loss instead of audit-based estimates of requirement. Introduction of Maximum Surgical Blood Ordering Schedule has implemented policies for blood ordering to improve blood stock management and prevent wastage. The British Society of Haematology recommendations is that blood is not made available unless usage is more than 50% which is equivalent to a C: T ratio of 2:1. Our study reflected the C: T ratio of 1.29:1.
There are several hazards of transfusion such as incorrect administered blood, acute and delayed transfusion reactions, transfusion-associated acute lung injury, transfusion-associated graft versus host reaction, posttransfusion purpura, and transfusion-transmitted infections; hence, if we ensure correct identification of patients who are really in need of blood, these hazards can be prevented. Therefore, reviewing of blood requisition in every hospital-based institutes holds its importance for appropriate use of blood and its products.
The decision to transfuse RBC is a complex one. It should not be based only on hemoglobin (Hb) level, but it should incorporate individual patient characteristics and symptoms. On the basis of Hb level, so many blood products are being requested, but not all are being transfused. To prevent this, many policies are made according to different guidelines, one of which is that transfusion is not indicated for Hb >10 g/dl; but the lower threshold varies from 6 to 8 g/dl.
The present study reflected the overall C/T ratio 1.29 which does not exceed 2.5 for any department in our center. The overall TI was found to be 0.77 and T% was 88.2%. All these figures are under the desirable range. The C/T ratio of various departments (orthopedics, neurosurgery, general surgery, and emergency) was 1.23, 1.49, 1.28, 1.37, and 1.54, respectively and is used by many authors for the evaluation of blood transfusion practices. Kuchhal et al., Tadesse, and Aruselvi et al. also found the overall C/T ratio to be within 2.5 in all the departments [Table 3]. However, Davoudi-Kiakalayeh et al. reported much higher C/T ratio which means large quantity of blood was ordered and cross-matched preoperatively for the patients, but most of it was held in reserve. There is lack of understanding among professionals regarding rational use of blood requisitions and needs to be strongly emphasize.
Thus, the study concludes that though the trauma center in our hospital meets the parameters required for blood transfusion, yet the departments requiring blood should critically analyze the need of blood requisition to minimize the blood bank load and cost.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]