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

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 (