Choosing Wisely:

Don’t order a Type & Crossmatch for patients undergoing procedures that have minimal anticipated blood loss, historically low fraction of transfusion use, and a low transfusion index (ratio of transfused units to patients).

Rationale and Comments: Appropriate use of blood component resources is critical to maintain adequate supply. For specific elective surgeries, the need for RBC transfusion may be anticipated; however, there is often over-ordering of RBCs and a lack of valid need. The Type & Crossmatch is labor and reagent intensive, resulting in increased workload costs and increased inventory wastage. Optimizing appropriate orders for a Type & Crossmatch can prevent these downstream detriments to effective, efficient care and stewardship of our blood supply. Development and implementation of an institutional-specific maximal surgical blood ordering schedule can aid in this endeavor, along with overarching education regarding transfusion best practices. Each hospital medical staff should have a maximal surgical blood ordering schedule and it should be available to all members of the medical and hospital staff, on request.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Surgical
  • Hematologic
  • References: • Frank SM, Rothschild JA, Masear CG, et al. Optimizing preoperative blood ordering with data acquired from an anesthesia information management system. Anesthesiology. 2013;118(6):1286-1297.
    • Collins RA, Wisniewski MK, Waters JH, et al. Excessive quantities of red blood cells are issued to the operating room. Transfus Med. 2015;25(6):374-379.
    • Frank SM, Oleyar MJ, Ness PM, et al. Reducing unnecessary preoperative blood orders and costs by implementing an updated institution-specific maximum surgical blood order schedule and a remote electronic blood release system. Anesthesiology. 2014;121(3):501-509.
    • Mahar FK, Moiz B, Khurshid M, et al. Implementation of maximum surgical blood ordering schedule and an improvement in transfusion practices of surgeons subsequent to intervention. Indian J Hematol Blood Transfus. 2013;29(3):129-133.

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