Pre-cesarean blood bank orders: a safe and less expensive approach.
OBJECTIVE
To 1) characterize pre-cesarean blood bank testing, 2) describe the transfusion experience in a large series of cesarean patients, and 3) evaluate safety and cost implications of a "hold clot" order for patients at low risk for transfusion.


METHODS
A review of 1111 consecutive cesarean patients used computerized perinatal and blood bank data bases and a detailed chart review of all cross-matched patients. Information collected included indications for cesarean and transfusion, etiology of hemorrhage, transfusion number and type, admission and lowest hemoglobin level, and information regarding the events leading to transfusion. A blinded review of the cross-matched patient's information assessed whether a cross-match was appropriate or could have been replaced safely by a "hold clot" (current clot tube in blood bank) order.


RESULTS
Nineteen patients (1.7%) were transfused. The only patients requiring a transfusion were diagnosed with placenta previa, placenta accreta, anemia, preeclampsia/hemolysis, elevated liver enzymes, low platelets (HELLP syndrome), or hemorrhage. A comparison of two blood banking approaches (routine pre-cesarean type and screen testing versus a "hold clot" order for cesarean patients at low risk for transfusion) indicated that the latter would reduce costs by $45 per cesarean, or $95,000 annually.


CONCLUSIONS
The incidence of transfusion was low (1.7%) and associated with specific diagnoses (previa, accreta, anemia, preeclampsia/HELLP, or hemorrhage). The data support the replacement of pre-cesarean type and screen testing with a "hold clot" order for patients at low risk for transfusion with negative prenatal antibody screen. This approach is safe and would reduce cost substantially.
Cousins
L M
LM
Mary Birch Hospital for Women, Sharp Memorial, San Diego, California, USA.
Teplick
F B
FB
Poeltler
D M
DM
D001771:Blood Banks / Q000191:economics; D001788:Blood Grouping and Crossmatching / Q000191:economics; D001803:Blood Transfusion / Q000191:economics; D002585:Cesarean Section; D003363:Cost Control; D005260:Female; D006801:Humans; D019106:Postoperative Hemorrhage / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D012307:Risk Factors