Removing the need for crossmatched blood in elective EVAR.

Abstract

The unit cost for crossmatching blood is £137.22 (€158.94). A maximum surgical blood order schedule for elective EVAR does not exist. We studied the crossmatch to transfusion ratio in our series to establish this recommendation. A single centre retrospective study of consecutive EVAR cases between October 2001 and December 2010. Blood loss, units transfused and indication for transfusion per case were analysed. 203 elective EVAR cases were studied. Median blood loss was 200 ml with a mean of 288 ml (range 50-8400 ml). A total of twelve patients (6%) required blood transfusion. Six cases (3%) for postoperative Hb <8 g/dL and three patients (1.5%) for medical complications. Three patients required a massive transfusion; two had peri-procedural haemorrhage and one patient developed a large groin haematoma. The crossmatch to transfusion ratio was 11.1. The maximum surgical blood order for elective EVAR should be a group and save (type and screen) sample because of the high crossmatch to transfusion ratio. Intraoperative transfusion is rarely required (<1%) but often necessitates large transfusion quantities. In this circumstance each hospital is required to have an emergency protocol to manage massive blood loss. Applying these principles across all surgical specialities may lead to significant financial savings, improve efficiency and reduce wastage.