Preoperative cross-matching in major elective surgical procedures in children: An audit of department's transfusion practices.

AIMS: To determine the utilization of cross-matched packed red blood cell (PRBC) concentrate in children posted for major elective operative procedures. To evaluate the efficacy of a simple preoperative "screening criteria" for ordering preoperative cross-match.

MATERIALS AND

METHODS

Data were retrieved from online surgery scheduling system prospectively over a 4-month period (January-April 2022). The number of units cross-matched and those utilized were assessed. A screening criterion was devised in consultation with stakeholders for ordering blood. The utilization of PRBCs was reassessed after implementation of these criteria and reaudited (July-October 2022). A subset analysis of A1 (tunneled catheter placements) and A2 (core pediatric surgical procedures) groups was done to analyze blood utilization.

RESULTS

Initial audit showed poor PRBC utilization with 46 units unused of the 54 cross-matched units, and most of these were from A1 group (3 of 29 units and 5 out of 25 units utilized in A1 and A2 groups, respectively). Reaudit after introducing cutoff criteria showed sharp decline (79.3%) in the number of cross-matched units and the number of units returned (84.6% decrease) in A1 group and the number of units returned unused dropped by 50% in the A2 group. There was visible reversal of indicators of utilization (cross-match to transfusion ratio dropped from 6.75 to 1.73 and TI increased from 0.163 to 0.613), indicating optimal utilization.

CONCLUSION

This pilot audit clearly demonstrates the gap between requisition and utilization of cross-matched PRBCs. Formulating an effective screening criterion avoids unnecessary cross-matching and wastage of resources and maximizes utilization.