Maximum Surgical Blood Ordering Schedule (MSBOS)

 

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A Maximum Surgical Blood Ordering Schedule is a mechanism to maximise usage of blood and minimise wastage in elective surgery. A Maximum Surgical Blood Ordering Schedule can reduce the workload of unnecessary crossmatching and issuing of blood and optimise stock management. The MSBOS only applies to elective surgery and requires samples being in the Transfusion Laboratory at least twenty four hours prior to surgery.  

For operations/procedures requiring a “group and save only” the following applies:

  • In Patients with a negative antibody screen blood can be available within 60 minutes if it is required urgently.
  • If patients have a positive antibody screen identified in the group and save sample cross-matched blood must be made available but surgery may well be delayed.

For operations requiring cross matched blood:

The designated number of units are reserved for the patient for 24hrs from the proposed date of surgery.

Crossmatched blood will be returned to the blood bank 24 hours post surgery unless otherwise requested by the clinician / ward. In the event of surgery being cancelled or postponed it is the responsibility of the clinician / ward to inform the blood bank of the change in circumstances.

  •  Four units of “O” Rh Negative red cells are available from the issue fridge in the laboratory
     For emergency use only.

The current MSBOS has been constructed by the Department of Haematology and Blood Transfusion with the Division of Surgery, Anaesthetics and Obstetrics / Gynaecology and is intended to act as a guide for generation of cross-matching requesting. Further revisions will be issued via the Hospital Transfusion Committee.

Surgical staff, ordering blood for theatre are asked to use the MSBOS.  It is essential that the clinical details, venue and date blood is needed are clearly indicated. 

Vascular Surgery 

  • Amputation of leg: G&S
  • Sympathectomy: G&S
  • Femoral Endartectomy: G&S
  • Carotid Endartectomy: G&S
  • Femoral-Popliteal bypass – Above knee: 2 Units
  • Femoral-Popliteal bypas - Below Knee: 4 Units
  • Axillo-femoral bypass: 4 Units
  • Axillo-bifemoral bypass: 6 Units
  • Aorto-iliac bypass: 4 Units
  • Infra-renal aortic aneurysm (elective): 6 Units
  • Ruptured aneurysms: >10 Units

 

Orthopaedic Surgery 

  • Removal hip pin or femoral nail: G&S
  • Osteotomy/bone biopsy (except under femur *): G&S (*2 Units)
  • Removal Cervical rib: G&S
  • Bone graft from iliac crest 1- side (both sides*): G&S (*2 Units)
  • Nailing fractured neck of femur: G&S
  • Spinal Fusion: 2 Units
  • Spinal Decompression: G&S
  • Internal fixation of femur: G&S
  • Internal fixation of tibia or knee: G&S
  • Arthroplasty - total knee or shoulder: G&S
  • Arthroplasty - total hip: G&S
  • Arthroplasty - total elbow: G&S
  • Changing hip prosthesis: 4 Units
  • Dynamic Hip screw: 2 Units
  • Total ankle replacement: 2 Units

 

General Surgery 

  • Cholecystectomy and exploration of common bile duct: G&S
  • Splenectomy – elective: 2-4 Units
  • Laparotomy - gastrostomy, ileostomy, colostomy: G&S
  • Laparotomy - elective – emergency (? Resection): G&S – 4 Units
  • Liver Biopsy: G&S
  • Oesophageal Dilation – endoscopic: G&S
  • Partial Gastrectomy – total: 2-4 Units
  • Hepatectomy - Trauma: >10 Units
  • Hepatectomy - Elective: 4 Units
  • Mastectomy (Simple): G&S

 

Endocrine 

  • Thyroidectomy – partial/total: G&S
  • Parathroidectomy: G&S
  • Adrenalectomy: 4 Units

Colo-rectal Surgery 

  • Rectum – pouch; resection/excision: 2 Units
  • Intra-abdominal colectomy, total: 6 Units
  • Intra-abdominal colectomy, sigmoid : 2 Units

 

Urology 

  • Nephrectomy: 4 Units
  • TURP: G&S
  • TUR bladder tumour (large tumour): G&S
  • Percutaneous nephrolithomy: G&S
  • Uterolithotomy: G&S
  • Cystomy: G&S
  • Uterolithotomy and cystotomy: G&S

 

Obstetrics & Gynaecology

  • APH/PPH: variable*:       G&S/2 units
  • Ovarian Cyst       : G&S
  • Hysterectomy –uncomplicated: G&S
  • Hysterectomy-Complex : 2-4 units
  • Laparoscopic Assisted Vaginal Hysterectomy (LAVH)
  • Laparotomy
  • Wertheim’s Operation
  • Cancer/Tumours/Masses- e.g. Pelvic, Ovarian, Cervical, Endometrial, Uterine
  • Total Abdominal Hysterectomy (TAH)
  • Bilateral Salpingo Oopherectomy (BSO)
  • Lymphadenectomy (Pelvic) :   variable*:           G&S/4 units
  • Laparoscopy: G&S
  • LSCS- uncomplicated:  variable* : G&S
  • LSCS-complicated: 2 units
  • ERPC/Miscarriage/D&C Hysteroscopy: G&S
  • Ectopic Pregnancy : variable*: G&S/2 units (if bleeding or ruptured)
  • Placenta Praevia: 2-4 units(repeat weekly)** - **Once inpatient crossmatch patient weekly
  • Retained Placenta/Manual Removal of Placenta (MROP): 2 units
  • Pelvic Floor Clearance:4 units
  • Pelvic Floor Repair : G&S (incl. Bladder Repair, Anterior-Posterior (AP) Repair)
  • Pelvic Exeneration: 6 units
  • Incontinence Sling Procedures e.g TVT, TOT, SPARK: G&S
  • Hydatiform mole: 2 units
  • Vulvectomy (radical)/ Vulval Intraepithelial Neoplasia (VIN): 4 units
  • Vesico Vaginal Fistula (VVF):2 units
  • Myomectomy: 2 units
  • Biopsy: G&S
  • Bilateral Tubal Ligation:G&S

 *Variable – Clinical Decision to Request G&S/Crossmatch

 

Radiology Intervention (Tests indicated)

  • Percutaneous Gastrostomy: INR, APTT, Platelet count
  • Oesophageal Stent: INR, APTT, Platelet count
  • Angiography Protocol: INR, APTT, Platelet count
  • Portcath, Hickman line & Haemolysis line insertion: INR, APTT, Platelet count
  • Nephrostomy Insertion: INR, APTT, Platelet count, G&S
  • Bilary Drain Insertion: INR, APTT, G&S
  • CT Body Biopsy i.e. Chest/Liver/Pancreas/Bone: INR, APTT, Platelet count, G&S
  • Abdominal drainage: INR, APTT, Platelet count, G&S
  • Uterine Fibroid Embolisation: INR, APTT, Platelet count

 

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