Analysis of homologous blood transfusion at the Okayama University Dental Hospital (Okayama University Medical and Dental Hospital)

In order to use transfusion blood effectively, maximum surgical blood order schedule (MSBOS) and Type and Screen (T & S) have been recommended. At Okayama University Dental Hospital, each responsible physician decided the blood preparation. A goal of this study was to analyze data related to transfusion during operation in Okayama University Dental Hospital, and compare it with the guidelines issued by the Ministry of Health, Labour and Welfare. Surgeries were divided into 6 categories: Tumorectomy, Tumorectomy and Neck dissection (ND), Radical and immediate reconstruction, Reconstruction, Benign tumorectomy, and Others. The cases were 145 cases operated from April 1, 1999 to March 31, 2004. Since Type and Screen (T & S) were introduced in the hospital in the middle of this period, the data were segregated by the introduction of the T & S. A transfusion ratio (percentage of transfusion per preparation) and ratio of cross-match to transfusion (C/T ratio) were calculated and compared with the guideline. Blood loss rate (> 600ml) was also figured out in each surgical category. Before the introduction of the T & S, in the "Radical and immediate reconstruction" category, transfusion ratio (percentage of transfusion per preparation) and ratio of cross-match and transfusion (C/T ratio) were 35.5% and 6.6, respectively. In the "Tumorectomy" category, the transfusion ratio and C/T ratio were 13.3% and 6.0, respectively. In the "Tumorectomy and ND" category the transfusion ratio and the C/T ratio were 7.9% and 24.9, respectively (Table 1, Fig. 2). In the "Radical and immediate reconstruction" category, much blood loss in occurred in 42% (Fig. 3) of the cases. Since the ideal value of the C/T ratio is 1.5 according to the guidelines, an amount of blood preparation before the introduction of the T & S was considered excessive in our facility (Fig. 1, 2). After the introduction of the T & S, all of the surgeries could be managed with the T & S (Table 2). However, in the "Radical and reconstruction" category, blood preparation should be considered for each case because of higher rate of large blood loss. Due to the introduction of the T & S, it became unnecessary to take the blood from the transfusion unit to an operation unit only for preparation. Thus, risks related to handling and transfer of blood can be reduced.