Reducing Rate of Crossmatch in Ob-Gyn Patients

Abstract

Abstract: Clinical reports and laboratory observations in the epidemiology suggested that the mortality and morbidity in mothers and their fetuses duning preonancy until a few weeks after buth outcomes were significantly associated with several risk factots and each patient had individualized risk rate. Thus, if we were able to identify the patients with high mortaity and motbidity risk and carefully manage such as good medicine, safety blood transfusion, safety delivery by skulled Ob-Gyn physians, and etc. These can ensure the decrease of the maternal-fetal mortality and complications. In 1999, 722 Ob-Gyn patients admitted at Uthaithaithanee Hospital were prospectively evaluated to determine which one of them required blood transfusion. It was found that compatibibity testings were performed on 1,043 units of blood. Ultimately, only patient (41%) with 49 units (4.7%) of blood were transfused. The small percentage of blood transfusion as compared to the large number of of crossmatch indicated unneccessary crossmatches which reflected the unneccessary blood bank work load. We studied and assessed the criteria for blood request in Ob-Gyn patients that had been set up the collaboration of Department of Obstetrics and Gynecology and Division of Blood Bank at Uthaithanee Hospital. The patients were divided into 3 group. Group included the patients with no no nisk and red no blood transfusion. Group I included the patients with low surgical nisk and may required blood transfusion. For this group routine pretransfusion testing which included ABO, Rh and antibody screening were performed, but crossmatches were not done until blood was actually requested and to be issued for transfusion. Group ll included the high risk patients who usually required blood transfusion. Then routine pretransfusion testing and crossmatches were performed as requested from the physicians.

In 2000, it was found that 5.1% (11/214) of hich risk patients (Group IIII) and 0%(4/516) of low risk patients (Group II) had ultimately received blood transfusion. There were four low risk patients who had been transfused in emergency, so that only an immediate spin crossmatch technigue were performed. However, there were no reports of transfusion reaction. There was no need to perform crossmatching for 512 cases of low risk patients which indicated that 1,025 units of blood were omitted from crossmatching. The significant reduced worldoad enables blood bank personnel to do more efficient work with high quaity for safety blood transfusion and also cost saving for the hospital and the patients.