Pre-cesarean blood bank orders: a safe and less expensive approach

OBJECTIVES: To 1) characterize pre-cesarean blood bank testing, 2) describe the transfusion experience in a large series of cesarean patients, and 3) evaluate safety and cost implications of a "hold clot" order for patients at low risk for transfusion. METHODS: A review of 1111 consecutive cesarean patients used computerized perinatal and blood bank data bases and a detailed chart review of all cross-matched patients. Information collected included indications for cesarean and transfusion, etiology of hemorrhage, transfusion number and type, admission and lowest hemoglobin level, and information regarding the events leading to transfusion. A blinded review of the cross-matched patient's information assessed whether a cross-match was appropriate or could have been replaced safely by a "hold clot" (current clot tube in blood bank) order. RESULTS: Nineteen patients (1.7%) were transfused. The only patients requiring a transfusion were diagnosed with placenta previa, placenta accreta, anemia, preeclampsia/hemolysis, elevated liver enzymes, low platelets (HELLP syndrome), or hemorrhage. A comparison of two blood banking approaches (routine pre-cesarean type and screen testing versus a "hold clot" order for cesarean patients at low risk for transfusion) indicated that the latter would reduce costs by $45 per cesarean, or $95,000 annually. CONCLUSIONS: The incidence of transfusion was low (1.7%) and associated with specific diagnoses (previa, accreta, anemia, preeclampsia/HELLP, or hemorrhage). The data support the replacement of pre-cesarean type and screen testing with a "hold clot" order for patients at low risk for transfusion with negative prenatal antibody screen. This approach is safe and would reduce cost substantially.

This article has been cited by other articles:

				D. J. Rouse, C. MacPherson, M. Landon, M. W. Varner, K. J. Leveno, A. H. Moawad, C. Y. Spong, S. N. Caritis, P. J. Meis, R. J. Wapner, et al. Blood Transfusion and Cesarean Delivery. Obstet. Gynecol., October 1, 2006; 108(4): 891 - 897. [Abstract] [Full Text] [PDF]