Increase Effectiveness of Blood Utilization and Reduce the Cost of Blood Request by Typing and Screening Protocol

Abstract

Abstract: Blood crossmatching request is routinely tested for ABO and Rh grouping, iregular antibody screening and crossmatching between patient serum and donor red cells. This type of request can matkedly reduce units of routine blood stock. Crossmatching in a surgical patient whose procedure rarely needs blood transfusion will increase laboratory workload and unnecessary cost. Typing
and screening (T&S) is the test that performs only ABO, Rh typing and inegular antibody screening. Crossmatching will be done when patients actually need transfusion. T&S will be an altemative for cost-effective surgical blood order. Objective: To study the rate of transfusion in surgical patients whose T&S were requested and to study the cost-effectiveness by ordening T&S instead of grouping and crossmatching in Songklanagarind Hospital. Methods: Surgical blood orders in a group of patients from various departments whose T&S were requested were reviewed during January 1999 to December 1999. Numbers of blood transfusion given to patients were collected from the record of the Blood Bank. The rate of transfusion was calculated. Number of blood units which were not transfused to the patients were calculated. The laboratory workload was estimated, the costs of blood requested by T&&S and crossmatching were compared. Results: T&S were requested in in 1,891 patients. There were 73 cases changed from T&S protocol to crossmatching prior and peri-operation. Only 43 out of these 73 patients received blood transfusion. The rate of transfusions was 2.3%. Therefore, there were totally 1,8 patients did not receive transfusion. There were 15-30% increasing of inventory blood levels: reducing 8,484 to 16,968 hours workdcads and saving 18.180 to 236.340 baht of patients expenses. Discussion and Conclusion: Surgical blood orders in patients who rarely need transfusion are unnecesssary tasks for blood bank staffs and may cause blood shortage. T&S request was introduced in the Blood Bank to mininimize these problems. The transfusion rate was found 2.3%. Therefore surgical blood orders of patients who were unlikely transfused should be T&&S.