الفهرس 
Practices in Blood TransfusionOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
triking a balance between the declining blood supply and increasing demand for blood has been a major challenge. This has led to attempts at providing guidelines for prudent utilization of blood. Additionally there is increasing demand for donor blood recruitment which has implications on the work load on blood bank staff. The increasing cost of collecting, sequestering and examining the blood is also an important limiting factor which lead us to cooperate together to get the best benefits from the available blood inventory.
A number of indices are used to determine the efficiency of blood ordering system. The use of cross-match to transfusion ratio (CTR) was first suggested by Boral Henry in1975. Subsequently, a number of authors used CTR for evaluating blood transfusion practice. Ideally, this ratio should be 1.0 but generally a ratio of 2.5 and below was suggested to be indicative of efficient blood usage, taking into consideration that the prepared units, which are not transfused, are not released from the bank to be suitable for reusage
Awareness of the hazards of blood transfusion is becoming more obvious due to the expansion of various aspects of blood transfusion services and the increased understanding of transfusion science in recent years. Serious hazards of transfusion are well documented which include incorrectly administered, early and delayed transfusion reactions, transfusion related acute lung injury, transfusion associated graft-versus host disease, post-transfusion purpura and transfusion transmitted infections. Cross matching blood only when genuinely required reduces the number of cross matches, saves the patient from an instinctive reaction, makes blood available and decreases blood bank costs.
In central blood bank of Ain Shams University Hospitals, we recorded CTR of 1.53 for all cross-matched orders representing T% of 65.23% over six months period.
CTR was higher in surgical cases compared to medical cases regarding all cross-matched orders and packed RBCs (1.70 vs 1.41, 1.77 vs 1.42 respectively)(P<0.01);while, there was no significant difference between both groups regarding FFP (P>0.05).
For all medical cases, CTR was estimated to be 1.42, 1.50 and 1 regarding packed RBCs, FFP and PLTs respectively. CTR was higher in general medicine and pediatric cases compared to medical oncology cases regarding all cross-matched orders (1.52, 1.41 respectively VS 1.10)(P< 0.01) . CTR was higher in pediatric and general medicine cases than medical oncology cases regarding RBCs (1.58, 1.39 respectively VS 1.18) (P<0.05). Regarding FFP, CTR was higher in general medicine cases compared to pediatric and medical oncology cases (1.71 VS 1.25, 1.00 respectively) (P<0.01).
For all surgical cases, CTR was estimated to be 1.77 and 1.40 regarding packed RBCs and FFP respectively. CTR was higher in urology, general surgery, plastic cases compared to orthopedic cases regarding all cross-matched orders (1.89, 1.70, 1.62 respectively vs 1.26) (P <0.05) and also regarding packed RBCs (1.96, 1.80, 1.68 respectively VS 1.26) (P <0.05); while, there was no significant difference in CTR between different surgical indications regarding FFP (P> 0.05).
In conclusion, CTR in Ain Shams University Hospitals was lower than standard ratio but still relatively higher in surgical indications compared to medical ones, which highlights the over-ordering of blood products in many elective general surgical operations. Policies for blood ordering should be applied to aid in decision-making and clinical judgment by expert medical personnel to avoid unnecessary cross-matching and promote a safe and cost- effective transfusion practice.