title: Blood transfusion requirements in elective breast reconstruction surgery.
abstract: BACKGROUND
  Excess-ordering of cross-matched blood in preparation for elective surgery is expensive with associated blood shortages and time-expired wastage. Although, the maximum surgical blood order schedule (MSBOS) for breast reconstruction recommends pre-operative cross-match of 2-6 units of red cell concentrate, there is no data confirming whether this guideline is observed in practice or whether compliance results in improved outcome. The aim of this study was to examine the utility of this MSBOS in clinical practice by assessing its performance in a validation set of patients.
  
  
  METHODS
  Over a three year period, 49 patients undergoing 50 consecutive elective breast reconstruction surgery were assessed for demographic data, surgical information and hematological/transfusion data to compare the number of units of blood cross-matched with those subsequently transfused for elective breast reconstruction surgery. This was in lieu of updating the current maximal surgical blood order schedule of cross-matching 2-6 units pre-operatively.
  
  
  RESULTS
  Fifty elective operations were undertaken during the study period with a zero peri-operative blood transfusion requirement and a 8% post-operative blood transfusion requirement. Pre-operative cross-match to transfusion ratio was unacceptably high with a time-expired blood wastage of 8.7%.
  
  
  CONCLUSIONS
  These data thus indicate that adoption of a type and screen policy is satisfactory for haemorrhage risk management of elective breast reconstruction. The MSBOS is not designed to predict post-surgery blood needs and a requirement based blood ordering protocol will optimise blood utilisation efficiency.
authors.affiliation: Department of Plastic Surgery, St John's Hospital at Howden, Livingston, Scotland, United Kingdom. sammyalbenna@googlemail.com
authors.forename: Sammy
authors.initials: S
authors.lastname: Al-Benna
authors.forename: Prachi
authors.initials: P
authors.lastname: Rajgarhia
mesh_terms: D000328:Adult; D001788:Blood Grouping and Crossmatching / Q000592:standards*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D016462:Mammaplasty / Q000592:standards*; D008875:Middle Aged; D059035:Perioperative Period; D017410:Practice Guidelines as Topic