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Original Article

Surgical blood ordering schedule for better

inventory management: An experience from a
tertiary care transfusion center

Pruthvi Raj Guduri a, Shamee Shastry b,*, Manish Raturi c, Anitha Shenoy d
a
Head (Transfusion Medicine), The Mission Hospital, Durgapur, West Bengal, India
b
Professor & Head (Immunohematology & Blood Transfusion), Kasturba Medical College, Manipal, Manipal
Academy of Higher Education, Manipal, Karnataka, India
c
Assistant Professor (Immunohematology & Blood Transfusion), Himalayan Institute of Medical Sciences, Dehradun,
Uttarakhand, India
d
Professor (Anesthesia), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal,
Karnataka, India

article info abstract

Article history: Background: Overordering of blood has been a challenge faced by the blood bank staff. The
Received 16 July 2019 present study addresses the role of maximum surgical blood ordering schedule (MSBOS) in
Accepted 9 July 2020 optimizing the blood inventory management.
Available online 9 October 2020 Methods: The blood requests for elective surgical procedures from various surgical de-
partments were reviewed to constitute MSBOS. Transfusion profile was assessed using
Keywords: crossmatch to transfused units (C/T) ratio, transfusion probability (TP), and transfusion
C/T ratio index (TI). A cutoff of 0.3 and 5% value of TI and TP, respectively, was considered to decide
Transfusion probability on the type of crossmatch. The efficacy of MSBOS implementation has been determined
Transfusion index prospectively by unpaired t test using SPSS software, version 20 (IBM, USA).
MSBOS Results: A total of 2674 patients were studied. Overall red cell usage rate was 15%. The
comprehensive C/T ratio was 4.57. The C/T ratios for the various departments ranged from
1 to 8.5 (adjusted C/T ratio). Highest C/T ratio was observed for surgical procedures per-
formed in the specialties of otorhinolaryngology and urology. A C/T ratio greater than 5
was noted in 30.4% of different types of surgical procedures. Of the 176 different types of
elective surgical procedures studied, type and screen protocol was applicable for 75.5%
(133) of the procedures. After implementation of MSBOS, the number of crossmatches
reduced by 2152 and total working time saved in our laboratory is close to 75,320 man
hours.
Conclusion: MSBOS helps in identifying the common surgical procedures with low TP and is
one of the efficient tools in preventing the overordering of the blood.
© 2020 Director General, Armed Forces Medical Services. Published by Elsevier, a division of
RELX India Pvt. Ltd. All rights reserved.

* Corresponding author.
E-mail address: shameeshastry@gmail.com (S. Shastry).
https://doi.org/10.1016/j.mjafi.2020.07.004
0377-1237/© 2020 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd. All rights
reserved.
284 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 8 ( 2 0 2 2 ) 2 8 3 e2 9 0
Introduction
Excessive blood requests are a common challenge faced by the
transfusion services. Nearly 66% of all the blood transfusions
are performed during the perioperative period.1 Previous
studies have revealed that there is gross overordering of blood
for elective surgical procedures, in excess of actual and
anticipated needs.2 In practice, whenever blood unit is cross-
matched for a patient, it is rendered unavailable to others
for 48 h and also results in aging of the blood unit during
reserved period.3 Considering the limited shelf life of blood
products, transfusion services may follow any one of the
several policies that help in making an efficient use of blood
bank inventory and consequently reducing the risk of out-
dating the blood units. One such policy that has been proven
to be successful in the practice of blood banking is the
maximum surgical blood ordering schedule (MSBOS).4 MSBOS
is a table of elective surgical procedures listing the number of
blood units to be cross-matched routinely. A recommended
MSBOS for common surgical procedures was published by
Freidman et al.5 However, with the constant change in the
surgical techniques, there is change in the utilization rate of
blood products. Hence, MSBOS needs to be reviewed and
updated regularly.
The MSBOS is supposed to guide and help in deciding the
ordering and transfusion of blood, but the final judgment is
left to the clinician.6 The main advantage with MSBOS is that
we can identify common surgical procedures with low trans-
fusion probability (TP) and minimal blood loss by analyzing
the preoperative blood orders so that the type and screen
(T&S) protocol can be safely applied to such procedures.7 Our
hospital is a 2032-bed tertiary care multispecialty teaching
institute with an average of one hundred surgeries (including
minor surgical procedures) performed daily with an approxi-
mate 120 units requested for elective surgeries per day.
Therefore, we aimed to develop MSBOS in our setup to opti-
mize the existing blood ordering practices.
Materials and methods
Study design
The study was carried out at a tertiary care center in South
India, by the department of immunohematology and blood
transfusion in association with the department of anesthesia.
This study was an observational and bidirectional study. The
study protocol was approved by the Institutional Ethics
Committee before its commencement. Patient consent for
inclusion in study was also obtained. The study consisted of
three phases:
Phase I: review and data analysis
The incipient phase consisted of retrospective review of the
blood ordering requests toward the elective surgical proced-
ures from the surgical departments. We have selected only
patients belonging to the American Society of Anesthesiolo-
gists Physical status Classification System (ASA) Grade I and II
who were scheduled for elective surgical procedures in the
aforementioned departments at our tertiary care center.7 The
sources of retrospective data collection were the cross-match
requisitions, preanesthetic checkup form, Blood Bank soft-
ware (Blood Bank, Data Management systems, Easy Software,
Ahmedabad, Gujarat), laboratory reports software (Lab infor-
mation systems), and the discharge summary. The data have
been collected for a retrospective period of 1 year.
Phase II: constitution of MSBOS
It involves 3 major steps. The first step that we have under-
taken was the identification of departments with frequent
elective surgeries being performed and the study protocol was
formulated. Step 2 involved retrospective analysis (phase 1). In
step 3, we evaluated the number of blood units transfused (T)
and the number of blood units cross-matched (C) for each
elective surgical procedure that was performed in patients
who met our inclusion criteria. The data of units requested,
cross-matched, issued, transfused were analyzed using the
standard known indices of blood usage analysis. Crossmatch
to Transfusion (C/T) ratio, TP, and transfusion index (TI) for
every specified elective surgical procedure has been deter-
mined. The following formulae were used during the study:
1. The formula for C/T ratio:
 No:of units cross matched
C T ratio ¼
No:of units transfused
1
½Value of < 2 is considered ideal
2. The formula for TP:
Transfusion probability %
No: of patients transfused
¼  100
No: of patients crossmatched
½Value of > 5% was considered ideal and a value < 5%
signifies no need for crossmatch for that particular
8
surgical procedure
3. The formula for TI:
Transfusion index
No:of units transfused
¼
No:of patients crossmatched
8
½Value of < 0:3 signifies no need for cross  match
4. Mead's criterion:[MSBOS ¼ 1.5 x TI]9
We henceforth drafted an MSBOS schedule using the
retrospective data. Elective surgical procedures were allotted
to two cohorts namely “Type and Screen” and or a “Type and
Crossmatch” category based on the transfusion indices
values. A T&S determines ABO blood group and Rh type and
screens for clinically significant alloantibodies in case a pa-
tient needs blood. A type and cross determines the same
information, but additionally performs a crossmatch be-
tween the patient's sample and a unit of blood to prepare a
 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 8 ( 2 0 2 2 ) 2 8 3 e2 9 0 285

product for immediate transfusion. A type and cross should
only be ordered if there is a high likelihood of transfusion. On
surgical procedures with TI value of <0.3 and TP < 5% only
T&S was performed and surgical procedures with TI value of
>0.3 and TP > 5% type and crossmatch was performed. The
number of units to be cross-matched for each surgery in type
and crossmatch was derived from Mead's criterion which
states that the maximum number of units to be cross-
matched for a particular surgical procedure is 1.5 times the
TI.9 The adjusted C/T ratio was also calculated and was
defined as the C/T ratio when only cross-matched blood used
intraoperatively was included in the calculation.2 Because we
considered only elective surgeries for this study, we have not
come across any clinical wastage of PRBC; therefore, we
justify the usage of C/T ratio rather than crossmatch to issue
ratio.
Phase III: implementation of MSBOS
The development and implementation of MSBOS was carried
out in accordance with the “guidelines for implementation of
an MSBOS” by the British Committee for Standards in He-
matology.10 Preimplementation consensus by stakeholders
such as surgeons, anesthetists, and blood bank was obtained
to ensure ease of implementation. It was put forward to our
Hospital Transfusion Committee comprising the medical
superintendent, chiefs of various surgical departments, and
the nursing superintendent all of whom approved it before its
implementation. The department-specific MSBOS charts
were circulated to the specific surgical departments, opera-
tion theaters (OTs), and were put up on the notice boards of
the wards. The OT staff and the blood bank crossmatch
laboratory technicians were informed about the imple-
mentation of the same and they were also provided the
approved charts of MSBOS. The analysis of the effectiveness
has been analyzed by unpaired t test after 6 months of the
implementation.
46 ± (19e68, SDd3.81) years. Gender ratio was 1.2:1 where
majority were men, 54% (n ¼ 1445/2674). The total number of
PRBCs requested was 5422 out of which only 813 units have
been transfused giving us a red cell usage rate of around 15%.
The comprehensive C/T ratio was seen to be 6.67. The highest
C/T ratio was seen for the surgical procedures belonging to the
otorhinolaryngology followed by the urology department.
Transfusion indices for different specialties are shown in
Table 1. The overall TI was less than 0.3 in all the specialties
and overall TP is greater than 30% for general surgery and
orthopedics specialties.
Analysis of the retrospective data of the transfusion prac-
tices revealed that of the 176 different types of elective sur-
gical procedures performed in different departments,
T&S protocol is applicable for 133 types of procedures (75.5%)
in patients belonging to ASA score I and II (Table 2). Type and
crossmatch of a single unit or two units is indicated in 43 types
of procedures (24.4%) (Table 2). When the C/T ratio for the
different types of surgical procedures was scrutinized, it was
noticed that C/T ratio of greater than 5 was noticed in 30.45%
of surgical procedures.
The blood ordering practices have been followed up for a
period of six months after implementation of MSBOS. In the
prospective study, we analyzed 1354 patients, for whom 2226
units have been cross-matched of which only 417 units were
transfused in this phase. The comprehensive C/T ratio has
showed a favorable reduction of 47% with a fall from 6.67 to
3.14. It has also been noted that there has been a rise in
T&S requests because the implementation of MSBOS (average
number of requests received per month before and after
implementation were 115 and 523, respectively). Because the
patients analyzed in the two phases of the study were
different, unpaired t test was utilized to find out the statistical
significance.
The department wise results are as follows

Obstetrics and gynecology

Results
A total of 2674 patients were included both retrospectively and
prospectively in this study. Patients were split into groups
based on the specialty and were further grouped based on the
type of surgery. The mean age of the population was
The transfusion profile was created for this specialty depicting
the various transfusion indices which revealed that elective
Lower Segment Cesarean Section (LSCS) with sterilization had
the highest C/T ratio. The greatest TP has been found for
elective LSCS with myomectomy. Adjusted C/T ratio value
was 3.05 comprehensively for this department. The reduction

Table 1 e Transfusion indices of the surgical departments of our hospital.

Sl. No. Description Sur Neuro OBG Ortho ENT Uro
1 Number of patients cross-matched 469 228 594 781 144 368
2 Number of units cross-matched 986 526 1156 1540 252 584
3 Number of patients transfused 98 61 79 295 8 15
4 Number of units transfused 147 79 118 343 12 29
5 Crossmatch/transfusion 6.70 6.65 9.79 4.48 21.5 20.13
6 Adjusted crossmatch/transfusiona 4.76 5.8 3.05 6.5 1.5 2.85
7 Transfusion index 0.31 0.34 0.19 0.43 0.08 0.07
8 Transfusion probability 31.3% 26.7% 13.3% 37.7% 5.5% 4.0%

Note: Sur (general surgery), Neuro (neurosurgery), OBG (obstetrics and gynecology), Ortho (orthopedics), ENT (otorhinolaryngology), Uro
(urology).
a
Adjusted C/T ratio is calculated only in cases were transfusions are performed.
 286
Table 2 e MSBOS chart.
Department Type and screen indications Indications for crossmatch of single Indications for
unit crossmatch of two units
Obstetrics and 1. Vaginal polypectomy 16. Cervical biopsy 31. Elective lower segment Caesarean Nil
gynecology (33 2. Cervical dilatation under 17. Diagnostic laparoscopy with chromotubation section with myomectomy
Procedures) ultrasound guidance 18. Diagnostic hysteroscopy 32. Total abdominal hysterectomy and
3. Cervical polypectomy 19. Cystectomy bilateral salpingo-oopherectomy
4. Colpofixation 20. Elective LSCS 33. Vaginal hysterectomy
5. D&C 21. Endometrial and cervical curettage
6. Elective LSCS with sterilization 22. Exploratory laparotomy
7. Excision of scar endometriosis 23. Laparoscopy
8. Hysteroscopy 24. Laparoscopy assisted vaginal hysterectomy and

m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 8 ( 2 0 2 2 ) 2 8 3 e2 9 0
9. Laparotomy bilateral salpingo-oopherectomy
10. Loop Electro Surgical Excision 25. Mirena insertion
11. Manual removal of placenta 26. Minilap sterilization - modified Pomeroy's
12. Modified Pomeroy's technique technique
13. Medical termination of 27. Myomectomy
pregnancy 28. Manual vacuum aspiration
14. Subtotal hysterectomy with 30. Bilateral labia major growth excision
bilateral salpingo-oopherectomy
15. Postpartum sterilization
Urology (20 1. BMG urethroplasty 11. Incision and drainage 19. Radical nephrectomy Nil
procedures) 2. End-to-end anastomotic 12. Transuretheral resection of prostate 20. Transuretheral Resection of Bladder
urethroplasty 13. Laparoscopic simple nephrectomy Tumors
3. Donor nephrectomy 14. Ureterolitotomy
4. Double-J stent removal Partial nephrectomy
5. Laparoscopic partial 15. Urethroscopic lithotripsy with double-J stenting
nephrectomy 16. Urethral dilation with cystoscopy
6. Pyelolithotomy 17. Visual internal urethrotomy
7. Inguinal orchidectomy 18. Partial nephrectomy
8. Ureteric reimplantation
9. Cystoscopy
10. Percutaneous nephrolithotomy
with double-J stenting
Otorhinolaryngology 1. Adenoidectomy 14. DNE cauterization 26. Total laryngectomy 29. Hemimandibulectomy
(29 Procedures) 2. Endoscopic adenoidectomy 15. Cochlear implant 27. Total thyroidectomy
3. FESS 16. Excision of cyst 28. Wide excision
4. Hemithyroidectomy 17. Hypopharyngoscopy
5. Incision and drainage 18. Laser-assisted tongue excision
6. Lipoma excision 19. Maxillary sinusotomy
7. Micro laryngoscopy 20. Myringoplasty
8. Septoplasty 21. Sistrunk operation
9. Septoturbinoplasty 22. Preauricular sinus excision
10. Nasal mass excision 23. Superficial parotidectomy
11. Submandibular gland excision 24. Young's operation
12. Tonsillectomy 25. Tracheostomy
13. Tympanoplasty
General Surgery (40 1. Amputation of Toe
Procedures) 2. Arthrotomy
3. Breast conservation surgery
4. Colonoscopy
5. Complete thyroidectomy
6. Endoscopic variceal ligation and
banding
7. Hemithyroidectomy
8. Flap reconstruction
9. Laparoscopic cholecystectomy
10. Laparotomy and Hydatid cyst
excision
11. Simple mastectomy
13. Ascitic tap 25. Abdominoplasty 37. Abdomino-perineal resection
14. Cholecystectomy 26. Above-knee amputation 38. Explorative laparotomy
15. Bilateral orchidectomy 27. Below-knee amputation 39. Hemicolectomy
16. Cyst excision 28. Hemorroidectomy 40. Total gastrectomy
17. Diagnostic laparoscopy 29. Hepatico-jejunostomy
18. Great toe amputation 30. Incisional hernioplasty
19. Forefoot amputation 31. Ileal resection anastomosis
20. Incision and drainage 32. Modified radical mastectomy
21. Laparoscopic hernioplasty 33. Open cholecystectomy
22. Transhiatal esophagectomy 34. Open incisional hernia repair
23. Sigmoid colectomy 35. Wide local excision
24. Wound debridement 36. Debridement

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12. Umbilical hernia repair
Neurosurgery (18 1. Abscess drainage 8. Laminectomy 14. Craniotomy 18. Occipital cervical fusion
Procedures) 2. Burr hole evacuation 9. Cranioplasty 15. Foramen magnum decompression
3. Disectomy 10. Frontal burr hole 16. Odontoid screw fixation
4. Endoscopic third 11. External Ventriclar drainage 17. Subdural hemorrhage evacuation
ventriculostomy 12. Microdisectomy
5. Mini craniotomy 13. VP shunt
6. Syringo pleural shunt
7. Thecoperitoneal shunt
Orthopedics (36 1. Antibiotic bead removal 13. Abdominal flap 24. Below-the-knee amputation 35. Above-knee amputation
Procedures) 2. Abscess drainage 14. Anterior cervical discectomy 25. Bipolar Hemireplacement 36. Dynamic hip screw fixation
3. Spinal stabilization and fusion 15. Antibiotic bead removal 26. Arthroplasty
4. Arthroscopic debridement 16. Cervical discectomy and fusion 27. Bone grafting
5. Bead application 17. Laminectomy 28. Cephalomedullary Nailing
6. Corticotomy 18. Decompression 29. Closed reduction þ screw fixation
7. Saucerization 19. Sequestrectomy 30. External fixator
8. Curettage and saucerization 20. Wound debridement 31. Intra Medullary nailing of femur
9. Discectomy 21. DHS removal 32. Foot amputation
10. External fixator removal 22. Intra medullary nail removal 33. Hemireplacement arthroplasty
11. Open reduction and internal 23. Total knee replacement 34. Total hip replacement (THR)
fixation
12. Implant removal
Total: 176 133 35 8

287
288 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 8 ( 2 0 2 2 ) 2 8 3 e2 9 0

Table 3 e Comparison of crossmatch to transfusion ratio.

S. No. Department Pre-MSBOS adjusted C/T ratio Post-MSBOS adjusted C/T ratio P value by unpaired t testa
1. Urology 2.85 1.83 <0.05
2. Otorhinolaryngology 1.50 1.47 0.10
3. Neurosurgery 5.80 3.13 <0.05
4. Orthopedics 6.50 4.27 0.10
5. General surgery 4.70 2.64 <0.05
6. Obstetrics and gynecology 3.05 2.01 <0.05

*p value of <0.05 is considered as significant.

surgical procedures that showed us favorable reduction in C/T

ratio were myringoplasty, septoturbinoplasty, and Sistrunk
operation with a percentage reduction of 69%, 63%, and 62%,
respectively.

Fig. 1 e Comparison of the number of type and screen tests
performed before and after implementation of MSBOS.
in adjusted C/T ratio was found to be statistically significant
after implementation of MSBOS (Table 3).
Urology
The top three surgical procedures with high C/T ratio values
were percutaneous nephrolithotomy with double-J (DJ)
stenting, TURP, and ureteroscopic lithotripsy with DJ stenting
(URS þ DJ stenting). Highest percentage of TP was observed
among the less commonly performed surgeries such as
radical nephrectomy, partial nephrectomy, and transur-
etheral resection of bladder tumors. The mean adjusted C/T
ratio of this department before the implementation of MSBOS
was 2.85 which scaled down to 1.83 because of the interven-
tion. The highest percentage reduction in C/T ratio was
observed in DJ stent removal procedure (60%).
ENT
The highest percentage reduction in C/T was observed in
preauricular sinus excision procedure (84%). The other
General surgery
A total of 40 elective surgical procedures were included from
this specialty. Maximum number of blood products have been
cross-matched for exploratory laparotomy and debridement
procedures. The TP of abdomino-perineal resection, hepatico-
jejunostomy, abdominoplasty, total gastrectomy, and hemi-
colectomy procedures is found to be greater than 30%. Surgi-
cal procedures with high C/T ratio were open cholecystectomy
(adjusted C/T ratiod3.8) and open incisional hernia repair
(adjusted C/T ratiod3.4). The most favorable reduction in the
C/T ratio after MSBOS was identified in hemithyroidectomy,
total thyroidectomy, and cholecystectomy with reduction
percentage values of 87%, 86%, and 82%, respectively.
Neurosurgery
Most units cross-matched in this specialty were for crani-
otomy, laminectomy, and discectomy. Very high C/T ratio was
found in discectomy and laminectomy followed by cranio-
plasty. A significant fall of 42% was noted in C/T ratio after
implementation of MSBOS. The highest percentage reduction
is observed in abscess drainage, discectomy, and micro-
discectomy with values of 71%, 67%, and 53%, respectively.
Orthopedics
The specific surgeries in orthopedics with very high C/T
ratio were total knee replacement, discectomy, and bead
application. The probability of transfusion was seen to be
highest for above-knee amputation (70.3%). The greatest
percentage reduction in C/T ratio was detected in the sur-
gical procedures of abscess drainage, bead application, and
total hip replacement with values of 78.75%, 75%, and
64.44%, respectively.

Table 4 e Transfusion indices in various other studies.

SL.No Study Year Sample Red cell usage C/T TP TI
8
1 Frank et al. 2013 53,526 32.6% NA NA 1.8
2. Aryal et al.6 2016 122 22.5% 4.44 9.83% 0.27
3. Yazdi et al.3 2016 398 26.9% 3.71 16.83% 0.31
4. Subramanian et al.15 2015 1109 39.7% 3.61 47.8% 0.39
5. Hall et al.2 2013 541 46.9% 2.6 34.5% 1.53
6. Bhutia et al.16 1997 680 40.23% 2.48 38.4% 1.6
7 Present study 2017 2674 15% 4.57 26.6% 0.3
 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 8 ( 2 0 2 2 ) 2 8 3 e2 9 0
Discussion
In this study, we have analyzed 5422 blood requests (3196
retrospective and 2226 prospective) in 2674 patients, which is
the largest sample evaluated to create MSBOS for an individ-
ual hospital in India till date. This is a study that involved
evaluation of blood requisitions from all surgical departments
in our hospital. Thereby, we studied the blood requests
received for 176 different types of elective surgical procedures
in six different surgical departments.
The strength of this study is that we selected only pa-
tients belonging to ASA Grade I and II who were scheduled
for elective surgical procedures in the aforementioned de-
partments at our tertiary care center to alleviate the con-
founding effect of comorbidities present in the patients.7
The blood ordering patterns of the elective surgical pro-
cedures performed in various departments at our center
showed that there is overordering of blood units. Before
implementation of MSBOS, in our hospital, the comprehen-
sive C/T ratio, TI, and TP were 4.57, 0.3, and 26.6%, respec-
tively. There has been overall increment in the monthly T&S
tests performed after implementation of MSBOS (Fig. 1). Our
TIs were high when compared with the study by Aryal et al,
wherein their indices C/T ratio, T%, and TI were 4.44, 9.83%,
and 0.27, which included multiple surgical departments6
(Table 4). We formulated MSBOS based on the TP and TI.
This method was adopted from the study by Mead et al on
chemotherapy in elective surgery.9
Total patients included in our study were 2674 with male
preponderance (54%) in comparison with the study by Kulkarni
that had a total number of 804 patients with female prepon-
derance (71.6%) in the study group with an age range from 15
to 65 years.11
We noted the overordering of blood for most of the lapa-
roscopic surgeries. Charvadeh et al. made similar observation
in their study on laparoscopic surgeries.12 Thabah et al., in
2013 conducted a study that revealed the different factors that
affect the C/T ratio.13 First, their study has acknowledged that
the distance of blood bank from their respective operating
theater and the effectiveness of the blood bank affect the
confidence of the surgeons and the anesthesiologists. Second,
the patient's preoperative condition also influences the blood
units requested; more blood units were ordered in patients
who looked anemic.14 Similarly many factors that are hospi-
tal-specific such as the transfusion practices, surgeons,
anesthetists, blood-sparing techniques followed influence the
MSBOS and differ from center to center. Hence, it is quite
essential that each center develop their individual center-
specific MSBOS.
The implementation of this system of MSBOS has led to a
significant abatement in the adjusted C/T ratio values of four
surgical departments, that is, urology, neurosurgery, general
surgery, obstetrics and gyneacology, which are the major
consumers. The general notion prevailing amidst clinicians
that PRBC crossmatch is mandatory for every surgery be-
forehand has to be ousted by our study which is mirrored by
the increasing T&S requests that the blood bank received after
the implementation of MSBOS (Fig. 1).
289
In the present study, we considered only ASA I and II pa-
tients for the development of MSBOS; hence, it is also appli-
cable only in patients who come under ASA score I and II.
Another limitation of this concept is that the MSBOS system
does not incorporate the individual differences in transfusion
requirements among patients undergoing the same proced-
ure. Patient-oriented factors sucha as patient weight and he-
matocrit which can influence the requirement of transfusion
have not been considered in the study.
Conclusion
The practice of MSBOS made a significant reduction in the C/T
ratio and the change implemented has in total miniaturized
the crossmatches by approximately 2152 at our center. The
average crossmatch time in our department is close to 35 min
in view of which the total working time saved in our labora-
tory is close to 75,320 man hours. The implementation of
MSBOS downsized the blood products being caught up in the
crossmatch-decross-crossmatch cycle which leads to aging of
the units and their unavailability. The number of free
uncrossmatched bags marked up which contributed in the
better inventory management by the blood bank staff.
Disclosure of competing interest.
The authors have none to declare.
Research involving human participants and/or
animals
This research involves human participants.
Informed consent
As per the hospital transfusion policy an informed consent
was obtained from all individual participants included in the
study.
Ethical approval
All procedures performed in studies involving human partic-
ipants were in accordance with the ethical standards of the
institutional ethics committee and with the 1964 Helsinki
Declaration and its later amendments or comparable ethical
standards. The study was approved before its commencement
by the Institutional Ethics Committee (IEC) with the reference
number IEC 507/2015.
Acknowledgments
The authors gratefully acknowledge the support of data entry
staff for their help in data compilation during the study.
290 m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 8 ( 2 0 2 2 ) 2 8 3 e2 9 0

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