Blood usage in elective surgery--a 3-month audit at Groote Schuur Hospital, Cape Town.

Unnecessary crossmatching of blood is expensive and can result in unwarranted transfusion with needles exposure of patients to the risks of transfusion therapy. Since the extent of unnecessary crossmatching and transfusion at Groote Schuur Hospital, Cape Town had not previously been considered in detail, blood usage in elective surgery was studied over a period of 3 months in 1990 to determine adherence to the Maximum Surgical Blood Ordering Schedule (MSBOS), crossmatch transfusion ratios (CTRs) and transfusion appropriateness. Just over half of blood bank requests were equal to or less than the MSBOS. The overall CTR in elective surgery for this period was found to be 1,7, which, not unexpectedly, is higher than that for the whole of Groote Schuur Hospital (1,4). However, it ranged from 1,4 in cardiac surgery to 4,7 for neurosurgery. Twenty-nine per cent of postoperative transfusions were considered to have been excessive. Transfusion therapy in the peri-operative period is discussed and possible changes in strategy are suggested.