University of Minnesota Brooklyn Center, Minnesota, United States
Background/Case Studies: Patients often require blood transfusions to compensate for blood loss during a surgical procedure. At our hospital transfusion services, most surgeons place red blood cell (RBC) orders ahead of the surgery, allowing the blood bank to rapidly issue compatible units as needed. However, a minority of surgeons neglect to order blood components before a surgery. This can cause delays when blood is needed, especially if the patient has RBC antibodies. To avoid these delays, we implemented a policy to review all scheduled surgical procedures for which: A) no blood was ordered and B) patients had a positive antibody screen. When deemed appropriate, ‘contingency units’ (CU) were prepared. In this study, we examined the usefulness of this policy by reviewing how often the CUs were used during a surgical procedure. This review will allow us to better understand this policy’s impact on patient safety.
Study
Design/Methods: The blood bank medical team reviewed pre-surgical request forms from January 1, 2020 to December 31, 2021. All pre-surgical patients who had a history of RBC antibodies and had no RBC units ordered for the surgical procedure were sent to the Transfusion Medicine MD (TMMD) for further review and recommendations for CU. The TMMD considered: likelihood of bleeding based on procedure type; and the rarity and severity of the antibody(s) involved. To assess the effectiveness of this policy we tabulated: the number of CUs prepared; the number of CUs released to the operating room (and not used); and the number of CUs transfused. Additional variables in the analysis included pre-surgery hemoglobin, history of blood disorders (i.e., sickle cell anemia, coagulopathies), and history of transfusion reactions. Statistical analyses were conducted using R version 4.2.2.
Results/Findings: During the study period 40,250 procedures were performed on 30,515 patients. A total of 536 procedures (1.33%) involved transfusions. During this period 140 cases met criteria for review by the TMMD, and 315 CUs were prepared. In 49 cases, 114 units (36.2%) were called for by the surgical team; in 26 cases 49 units (15.6%) were transfused during the procedure . There were 66 cases with 201 CUs (63.8%) that remained in the blood bank, unused. Overall, the most units were used by the cardiovascular service (Table.1) Conclusions: The application of the screening policy for pre-surgical patients with RBC antibodies was an effective policy that contributed to patient safety. We estimate that this screening program averted delays in at least 26 cases, shortening the time that patients were under anesthesia, and most likely decreasing expenditures for operating time.
Importance of research: Delays in preparing compatible RBC units for surgical procedures can impact patient safety, especially for those patients with antibodies against RBC antigens. Our hospital implemented a policy to screen the OR cases in which patients had RBC antibodies and no units ordered by their surgical team. If the risk of transfusion was high or the patient had an alloantibody against a common antigen, contingency units would be prepared. This study assessed the usefulness of that policy.
