Maximum surgical blood ordering schedule

The Maximum Surgical Blood Ordering Schedule is a list of operative procedures with recommendations for the amount of blood that should be cross-matched for the patient pre-operatively. In many instances the recommendation will be a group and save procedure (G+S). However, the patient’s clinical condition must be considered. In certain circumstances it may be necessary to modify the MSBOS if, for example, a patient is very anaemic pre-operatively or has a pre-existing bleeding tendency.

For elective surgery, in order to ensure that a group and save sample is processed before the patient goes to theatre it must be received in the Transfusion Laboratory with a minimum of 24hrs notice but preferably 48hrs in advance. The less notice that is given the less likely the sample will be processed before theatre. Elective cross-match samples require a minimum of 24hrs notice. Where possible transfusion samples should be taken at surgical pre-assessment clinics. To allow the laboratory staff to prioritise their workload the time and date of the planned operation must be given. The Transfusion Laboratory blood stocks are topped up five days a week by the Blood Transfusion Service in Glasgow. To ensure efficient stock management it is essential that adequate notice of all elective cross-matches is provided.

In an acute situation a group and save sample can be converted into a cross-match and blood provided within 40 minutes. If a sample has been grouped, uncross-matched group specific blood can be provided within 10 minutes of a telephone call to the laboratory. Any group and save sample that has clinically significant antibodies is automatically cross-matched. If an antibody has previously been reported the Transfusion Laboratory should be contacted and a sample sent at the earliest opportunity to ensure there is sufficient time available to obtain suitable blood and cross-match these patients.

• It allows blood stocks to be used more efficiently and appropriately and thereby reduces wastage.
  Allows more time and resources for patients requiring transfusion support and makes available rapid delivery when group and save samples are converted to a cross-match.
• It increases the safety of the blood stock as blood is less likely to be out with the main laboratory storage facilities unless it is to be transfused. Storage conditions of blood and blood products critically affect the safety of the products.
• It is designed to reduce unnecessary workload in the Hospital Transfusion Laboratory and allows more time to respond to emergencies and to investigate complex serological problems.

It should be noted that the recommended tariff should be varied if the patient has exceptional clinical or laboratory features. These would include:

• Cardiac disease - It is currently recommended that patients with cardiac disease have their Hb maintained at 100g/l. Therefore patients with known cardiac disease who have a borderline pre-operative Hb should be cross-matched if significant blood loss is expected (i.e. 500mls or more)
•  Pre-existing anaemia (Hb below 90g/l for example)
• Suspected malignancy
• Sepsis
• Known significant coagulopathy (e.g. PTR or APPTR  above 1.5 or a platelet count below 80).
• Patients with known red cell antibodies