A study of blood utilization in association with specific pediatric procedures

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand | 2019 Background: The average blood product ordered for elective pediatric procedures were double when compared to the data on the same procedures for adults. Most of the blood product preparation was not used. Objective: To reduced unnecessary pre-operative blood orders and costs under patient safety rule. Materials and Methods: The data were collected from pediatric patients that underwent transanal endorectal pull-through (TERPT), posterior sagittal anorectoplasty (PSARP), and colostomy closure over a 29 months period. A crossmatch-to-transfusion ratio (C/T ratio), transfusion probability (%T), and transfusion index (Ti) were calculated for each type of procedure. A new maximum surgical blood order schedule (MSBOS) was created and introduced. Total cost of blood preparation and transfusion were analyzed to assess the efficacy and safety of the new policy. Results: One hundred eighteen pediatric patients were crossmatched pre-operatively. The number of units crossmatched varied in range between 1 and 4. Of the 239 units of blood crossmatched, only two units were transfused. TERPT had a %T of zero and a C/T ratio equal to infinity. PSARP and colostomy closure had a low transfusion probability (%T <5%), and a C/T ratio of more than 2:1. Implementing the new policy resulted in reduction in the cost of blood preparation and transfusion by 300 Baht (US$ 8.57) per person for TERPT and 180 Baht (US$ 5.14) per person for PSARP and colostomy closure. Conclusion: The authors’ analysis confirmed that excessive crossmatching occurred for several pediatric procedures. Regular auditing and revising of policies should be encouraged and applied in all procedures for better blood utilization and cost reduction in the future.