Type and Crossmatch tests in Urologic Elective Surgery: Our practice and thoughts for the future 
Leonor Silva-e-Sousa1, Patrícia Martins1, Diogo Albuquerque1, Manuel Abecasis1, Inês Pereira1, Ana Paulino1
1 – Anaesthesiology Department, Santa Maria Hospital, North Lisbon Hospital Centre
Background and Goal of Study

Preoperative blood orders for surgical procedures are defined by the Maximum Surgical Blood Order Schedule (MSBOS). 30 years after its creation, the MSBOS needs to be updated. Recently, new protocols with new indications have urged. However, they are inconsistent between centres and don’t take account to the pre-operative haemoglobin (Hb) value. One of the most consistent protocols was recently published by John Hopkins Hospital (JHH). Our main objective was to identify if type and crossmatch tests (T/C) in patients undergoing urologic elective surgery in our centre are in line with JHH’s recommendations. As a secondary objective we wanted to identify the percentage of red blood cells units (RBCU) previously studied that were administrated in the first perioperative 48 hours, and if the baseline value of Hb was associated with the transfusion decision. 

Materials and Methods

Study in which the number of RBCU studied before each urologic elective surgery in the period of 2 months were evaluated, as well as the ones that were transfused in the first 48h. The patients were divided into 2 groups accordingly to the needs of T/C defined by JHH’s MSBOS. Within the group with indication to do T/C, using the application of the T-student test, it was analysed if the pre-operative Hb value was associated with the realisation of the transfusion. Patients with pre-operative Hb values that solely justified the RBCU transfusion were excluded. 
Results
From October 1st to November 30th of 2015, 92 surgical interventions were registered with an adequate Hb value. Patient’s average age was 64 years (SD14,2), 70 of them being males (74%), and they had an average Hb level of 13,6 mg/dL (SD1,7). 66 RBCU were studied and 9 were transfused. In the group without indication for T/C, 19% where studied, and in the group with indication 18% were not submitted to T/C. In the total of the studied patients 15% where transfused, and in the group with T/C indication, RBCU was administered in 16% of them. In the latter group, with an average Hb value of 13,4 mg/dL (SD1,89), the pre-operative Hb value was associated with the need to transfuse the patient in the first 48h (p=0,01, SD 0,51-3,61).
Conclusions
The lack of institutional protocols contributes to disparities in the indication to execute preoperative blood orders. Our results suggest that a higher threshold may be necessary for this indication, and that the pre-operative Hb value should integrate the decision algorithm.

Type and crossmatch tests in urologic elective surgery: our practice and thoughts for the future