Maximum surgical blood ordering schedule for common orthopedic surgical procedures in a tertiary hospital in North Central Nigeria

Background: Blood transfusion is an important part of management of patients undergoing orthopedic surgeries. However frequently perioperative anticipated blood requirements overshoot the actual need resulting in unnecessary cross matching of blood. Therefore, it is important to formulate a maximum surgical blood ordering schedule (MSBOS) for common orthopedic surgeries.

Objective: To evaluate our blood utilization in various orthopedic surgeries and to develop a blood ordering schedule for various orthopedic surgeries.

Methodology: A 12-month (January-December 2016) retrospective study was carried out on patients undergoing orthopedic procedures. Data collected included number of patients transfused, number of units cross-matched and number of units transfused. The cross matched to transfusion ratio (CTR), transfusion probability and transfusion index were calculated and from the calculated values a MSBOS was proposed.

Results: A total of 224 units of blood were cross matched for 105 patients out of which only 97 units of blood was transfused to 55 patients. Nine out of 15 surgical procedures had CTR higher than 2, 4 had a low TI <0.5 and 12 had a blood utilization of <50%. Fracture of the forearm, total knee replacement (unilateral), tibiofibular and ankle fractures all had blood utilization of <30% and thus Type & Screen policy was recommended for these procedures.

Conclusion: The overall CTR was high with low percentage blood utilization and resultant significant blood wastage. To prevent unnecessary blood wastage, we suggest the implementation of the recommended MSBOS schedule.