ASSESSMENT OF BLOOD UTILISATION IN SURGICAL PATIENTS AT A TERTIARY CARE CENTRE: A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Rational utilisation of blood components is an essential aspect of transfusion medicine, specifically in areas where blood resources are limited. An excessive preoperative crossmatching may lead to unnecessary depletion of blood bank stocks and increased laboratory workload, while insufficient availability may result in delayed transfusions during unplanned emergency surgical haemorrhage. The Crossmatch-to-Transfusion (C/T) ratio and Transfusion Probability (TP) are widely used indicators of blood utilisation efficiency. Methods: This study was a retrospective observational study conducted at Saveetha Medical College and Hospital from November 1, 2023, to January 31, 2024. Data pertaining to surgical patients for whom packed red blood cells (PRBCs) were crossmatched were collected from blood requisition forms, crossmatch and issue registers, and digital medical records. Demographic characteristics, surgical speciality, number of units crossmatched, and number of units transfused were recorded. Blood utilisation was assessed using the C/T ratio and TP. The C/T ratio was calculated as the number of units crossmatched divided by the number of units transfused, while TP was calculated as the percentage of patients transfused among those crossmatched. Results: Out of 1,031 surgical admissions during the study period, 837 patients underwent PRBC crossmatching, involving 1,233 units. Of these, 274 patients received transfusion, with a total of 499 PRBC units transfused. The overall C/T ratio was 2.47, while the overall TP was 32.7%. Considerable variation was observed among surgical specialities. Cardiothoracic and Vascular Surgery demonstrated efficient utilisation, with a C/T ratio of 1.19 and TP of 65.2%, whereas Obstetrics and Gynaecology had a C/T ratio of 5.1 and TP of 19.2%, suggesting substantial over-ordering and underutilization of crossmatched blood. Among transfused patients, 164 underwent elective procedures, and 110 underwent emergency procedures. Conclusion: The overall blood utilisation was within normally accepted C/T and TP benchmarks; however,  interdepartmental variation was identified. Departments demonstrating inefficient blood utilisation, reflected by high C/T ratios (>2.5) and low transfusion probability (<30%), may benefit from procedure-specific and risk-stratified blood ordering practices, including implementation of Maximum Surgical Blood Ordering Schedules (MSBOS), Type and Screen protocols, regular blood utilisation audits, and clinician education. These measures may reduce unnecessary crossmatching, improve blood availability, and promote effective patient blood management.