Maximum Surgical Blood Order Schedule - the Royal Cornwall ...

Document Title
Type of document
Brief summary of contents
Executive Director responsible for
Policy:
Directorate / Department responsible
(author/owner):
Maximum Surgical Blood Order Schedule
(MSBOS)
Corporate: Clinical
Provides indication for appropriate blood
ordering
Medical Director
Dr Richard Noble, Haematology
Consultant
Contact details: 01872 252506
Date written: 01/07/2007
Date revised: 12/04/2011
This document replaces (exact title of
previous version):
Approval route (names of
committees)/consultation:
Divisional Manager confirming
approval processes
Name and Post Title of additional
signatories
Equality Impact Assessment appended
Approval must not be given if the EIS
is not attached
Signature of Executive Director giving
approval
Publication Location (refer to Policy
on Policies – Approvals and
Ratification):
Document Library Folder/Sub Folder
Maximum Surgical Blood Order Schedule
V 2
Hospital Transfusion Team
{Original Copy Signed}
Yes
{Original Copy Signed}
Internet & Intranet Intranet Only √
Date of final approval: 11 th May 2011
Date policy becomes live: 11 th May 2011
Date due for revision: 12 th April 2014
Administration of Blood Components
(BCSH Guidelines)
Links to key external standards Guidelines for the Clinical Use of Red Cell
Transfusions
Better Blood Transfusion (BBT) 3
Related Documents:
Transfusion Policy
Transfusion blood ordering surgery red
Suggested Keywords:
cells MSBOS
Training Need Identified?
No

This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy on Document Production. It should not be altered in any way without the
express permission of the author or their Line Manager.
Date
Version
No
June 2007 V1 New Document
Summary of Changes
Changes Made by
(Name and Job Title)
Stephen Bassey,
Transfusion
Laboratory Manager
July 2009 V2 Minor changes Stephen Bassey
April 2011 V3 Revision and reformatting throughout
Dr Richard Noble,
Haematology
Consultant
All or part of this document can be released under the Freedom of Information Act
2000
This document is to be retained for 10 years from the date of expiry.

RCHT Maximum Surgical Blood Ordering Schedule (MSBOS)
The MSBOS is a guide to help ensure that blood is available at elective surgery.
This guidance is not absolute and factors other than the type of surgery (eg low Hb, antiplatelet
drugs, bleeding tendency, previous surgery, co-morbidities etc) should be considered with respect
to both the choice of hospital site and the availability of cross-match.
Important Information:
There must be a valid Blood Group and Antibody Screen (G+S) specimen in the lab to supply any
blood except emergency O neg. A G+S specimen is valid for a maximum of 7 days.
The sole function of a G+S specimen taken in a pre-operative assessment clinic is to identify the
presence of red cell antibodies and allow appropriate planning (ie order in antigen negative red
cells which may need to come from Bristol). It does not contribute to the availability of blood at
surgery for which a specimen < 7 days old must be available.
If there is a risk of significant blood loss at surgery then a valid G+S specimen should be supplied
within the 7 days preceding surgery.
If e-matched * blood is required this specimen must be supplied 2 hours before surgery to allow an
automated blood group check and antibody screen. If surgery proceeds and blood loss occurs
before this automated check is performed then cross-matched blood should be requested and this
takes 45 min. If blood is required within 45 mins, group specific blood can be supplied within 15
mins. The lab must be informed.
When antibody has been identified in the pre-op assessment clinic it is the responsibility of this
clinic to ensure a valid G+S specimen, and cross-matched blood if necessary, is made available
for surgery. This MSBOS advises how many units should be ordered in.
In the absence of antibody it is the responsibility of the surgeon to supply a G+S specimen if
considered necessary. Unless the patient is admitted at least half a day before surgery this
specimen will most often be taken on admission. In the event of blood loss patients first on the list
will require cross-match. If essential emergency O neg † and group specific blood is available
during the interval between receipt of a G+S specimen and cross-matched or e-matched blood
becoming available.
For very low risk procedures a G+S specimen is not required.
For surgery on other sites the G+S specimen must be supplied to the RCHT site. If there is a risk
of requiring transfusion there may be a lower threshold for taking a G+S specimen, and it is wise
to ensure this G+S specimen arrives at the RCHT site before the commencement of surgery. If
there is substantial risk then surgery might better be performed on the RCHT site.
The time required for transport will delay availability: the case mix at WCH and SMH would
suggest that this delay is acceptable.
† O neg blood is available as follows: WCH 4 units
SMH
4 units
RCHT Transfusion lab 4 units
Main theatre 2 units
Trauma theatre 2 units
Duchy Hospital 2 units
Bodmin Hospital 2 units
* e-match: e-match is the supply of blood on the basis of a confirmed blood group and a
negative antibody screen: blood does not need to be cross-matched and so can be dispensed
within 5 minutes of request.
e-match is only allowable where a patient’s plasma does not contain (or has not been
known to contain) red cell antibodies, where there is no history of a solid organ transplant, and
where there has been sufficient time for a valid (

If there is a particular individual risk of significant blood loss (eg low Hb, clotting risk, previous surgery etc),
consider triage to RCHT and err on the side of ensuring a G+S specimen is available ahead of surgery
NB this pre-op clinic specimen serves as an antibody screen and does not mean that e-matched blood will be available at surgery
▼
Pre op clinic
On day of surgery
GENERAL SURGERY
WCH / SMH RCHT If antibodies
detected
Abdominal-perineal resection G & S G & S 2 UNITS
BREAST
Cholecystectomy G & S G & S G & S
Colectomy G & S G & S
Gastrectomy - Partial G & S G & S
Hemicolectomy G & S G & S
Laparotomy (Malignancy or Crohn’s) G & S G & S 2 UNITS
VASCULAR
Anterior resection rectum G & S G & S 2 UNITS
Pan-proctocolectomy G & S G & S 2 UNITS
Splenectomy G & S G & S 4 UNITS
Major reconstruction G & S G & S 2 UNITS
Mastectomy G & S G & S 2 UNITS
Aneurysm G & S G & S 4 UNITS
Aorto-femoral graft G & S G & S 4 UNITS
Carotid G & S G & S 2 UNITS
Femoro-popliteal graft G & S G & S 2 UNITS
Profundaplasty G & S G & S 2 UNITS
BKA G & S G & S 2 UNITS
AKA G & S G & S 2 UNITS
EVAR G & S G & S 4 UNITS
NB for MAJOR emergency blood loss eg for aortic aneurysm rupture a trauma pack should be requested
and includes 6 units blood + 4 units FFP, followed by 6 units blood, 4 FFP + 1 platelets repeatedly until the lab is stood down
◄
NB if Ab detected blood must be requested well in advance as it may
have to come from Bristol.
Author: Dr Richard Noble Page 2 of 4
MSBOS V3 Date of issue: 12/04/2011

If there is a particular individual risk of significant blood loss (eg low Hb, clotting risk, previous surgery etc),
consider triage to RCHT and err on the side of ensuring a G+S specimen is available ahead of surgery
NB this pre-op clinic specimen serves as an antibody screen and does not mean that e-matched blood will be available at surgery
▼
Pre op clinic
On day of surgery
OBSTETRICS AND GYNAECOLOGY
WCH / SMH RCHT If antibodies
detected
APH / PPH G & S n/a
APH (significant) 2 UNITS (variable) n/a
Caesarian section (LSCS) G & S G & S 2 UNITS
ERPC (D+C) G & S n/a
Ectopic pregnancy - if ruptured 2 UNITS n/a
- laparotomy G & S n/a
Hysterectomy - total abdominal G & S G & S 2 UNITS
- vaginal G & S G & S 2 UNITS
- laparoscopic G & S G & S 2 UNITS
- radical for vaginal cancer G & S G & S 2 UNITS
Laparotomy for advanced ovarian cancer G & S G & S 2 UNITS
Myomectomy G & S G & S 2 UNITS
Oophorectomy (cyst) - benign G & S G & S 2 UNITS
Placenta praevia G & S n/a
Placenta removal - manual G & S n/a
Termination (TOP) G & S G & S 2 UNITS
Trial of scar G & S G & S 2 UNITS
Vaginal prolapse repair G & S G & S 2 UNITS
Vulval cancer radical surgery G & S G & S G & S
NB for MAJOR emergency blood loss eg for aortic aneurysm rupture a trauma pack should be requested
and includes 6 units blood + 4 units FFP, followed by 6 units blood, 4 FFP + 1 platelets repeatedly until the lab is stood down
◄
NB if Ab detected blood must be requested well in advance as it may have to come from Bristol.
Author: Dr Richard Noble Page 3 of 4
MSBOS V3 Date of issue: 12/04/2011

If there is a particular individual risk of significant blood loss (eg low Hb, clotting risk, previous surgery etc),
consider triage to RCHT and err on the side of ensuring a G+S specimen is available ahead of surgery
NB this pre-op clinic specimen serves as an antibody screen and does not mean that e-matched blood will be available at surgery
Orthopaedics
Urological Surgery
ENT
Bariatric
▼
Pre op clinic
On day of surgery
WCH / SMH RCHT If antibodies
detected
# NOF 2 UNITS
Osteotomy (tib / fib) G & S 2 UNITS
THR G & S 2 UNITS
THR revision G & S G & S G & S 4 UNITS
TKR G & S 2 UNITS
Nephrectomy G & S G & S 2 UNITS
Prostatectomy TUR and RRP G & S G & S 2 UNITS
TUR of bladder tumour G & S G & S 2 UNITS
Block dissection of neck G & S G & S 2 UNITS
Laryngectomy G & S G & S 2 UNITS
Gastric Band G & S G & S 2 UNITS
Gastric Bypass G & S G & S 2 UNITS
NB for MAJOR emergency blood loss eg for aortic aneurysm rupture a trauma pack should be requested
and includes 6 units blood + 4 units FFP, followed by 6 units blood, 4 FFP + 1 platelets repeatedly until the lab is stood down
◄
NB if Ab detected blood must be requested well in advance as it may have to come from Bristol.
Author: Dr Richard Noble Page 4 of 4
MSBOS V3 Date of issue: 12/04/2011

Appendix 1.Initial Equality Impact Assessment Screening Form
Name of service, strategy, policy or project (hereafter referred to as policy) to be
assessed:
Maximum Surgical Blood Order Schedule (MSBOS)
Directorate and service area:
Is this a new or existing Procedure?
Specialty/Surgery
Existing
Name of individual completing
Telephone: 01872 253093
assessment: Nicki Jannaway
1. Procedure Aim* Provides indication for appropriate blood ordering
2. Procedure Objectives* To ensure adherence to national guidelines on provision of
blood during surgical interventions
3. Procedure – intended To support medical and laboratory staff in decision making
Outcomes*
process.
4. How will you measure
the outcome?
5. Who is intended to
benefit from the
Procedure?
6a. Is consultation
required with the
workforce, equality
groups etc. around this
procedure?
b. If yes, have these
groups been consulted?
c. Please list any groups
who have been consulted
about this procedure.
Daily monitoring by BMS staff during course of provision of
blood.
Laboratory and medical staff, patients.
Yes
Yes
Consultant Anaesthetists and Consultant Surgeons
HTT
*Please see Glossary
7. The Impact
Please complete the following table using ticks. You should refer to the EIA guidance
notes for areas of possible impact and also the Glossary if needed.
Where you think that the policy could have a positive impact on any of the equality
group(s) like promoting equality and equal opportunities or improving relations
within equality groups, tick the ‘Positive impact’ box.
Where you think that the policy could have a negative impact on any of the equality
group(s) i.e. it could disadvantage them, tick the ‘Negative impact’ box.

Where you think that the policy has no impact on any of the equality group(s) listed
below i.e. it has no effect currently on equality groups, tick the ‘No impact’ box.
Equality
Group
Age
Positive
Impact
Negative
Impact
No
Impact
√
Reasons for decision
Disability
√
Faith and
Belief
√
Refer to Blood and Blood
Product Refusal policy.
Gender
√
Race
√
Sexual
Orientation
√
You will need to continue to a full Equality Impact Assessment if the following have
been highlighted:
A negative impact and
No consultation (this excludes any policies which have been identified as not
requiring consultation).
8. If there is no evidence that
the policy promotes equality,
equal opportunities or improved
relations - could it be adapted
so that it does? How?
Full statement of commitment to policy of
equal opportunities is included in the policy
Please sign and date this form.
Keep one copy and send a copy to the Human Resources Team, c/o
Royal Cornwall Hospitals NHS Trust, Human Resources Department, Lamorna House,
Penventinnie Lane, Truro, Cornwall, TR1 3LJ
They will
arrange for a summary of the results to be published on the Trust’s web site.
Signed ________________________________________
Date _________________________________________