Australian and New Zealand Society of Blood Transfusion
The Australian and New Zealand Society of Blood Transfusion comprises over 400 members from diverse scientific, medical and nursing backgrounds working within the area of blood transfusion and related fields. NB. These recommendations do not apply to emergency situations, severe acute bleeding and acute phase of major trauma resuscitation.
4.
Do not order a group and crossmatch when a group and antibody screen would be appropriate.
Do not order a group and crossmatch when a group and antibody screen would be appropriate.
Modern on-site laboratories can issue compatible blood within minutes if the patient has a valid group and screen and no clinically significant red cell antibodies.
Cross-matching blood unnecessarily increases total inventory levels, increases the average age at which units are transfused, increases blood wastage and creates additional work and costs associated with transfusion.
If an on-site laboratory is not available, then cross-matching should be guided by a Maximum Surgical Blood Ordering Schedule (MSBOS) to minimise wastage.
For patients with antibodies laboratories should have a policy related to cross matching blood for those patients who have difficult to match antibodies.
Supporting evidence
Frank et al, ‘Reducing unnecessary preoperative blood orders and costs by implementing an updated institution specific maximum surgical blood order schedule and a remote electronic blood release system’. Anesthesiology 2014; 121: 501-9 https://pubmed.ncbi.nlm.nih.gov/24932853/
Hall et al, ‘Blood Transfusion Policies in Elective General Surgery: How to Optimise Cross-Match-to-Transfusion Ratios’, Transfus Med Hemother 2013;40:27–31. https://pubmed.ncbi.nlm.nih.gov/23637646/
Novis et al, ‘Quality Indicators of Blood Utilization’, Arch Pathol Lab Med 2002 Feb; 126(2): 150-156. https://pubmed.ncbi.nlm.nih.gov/11825109/
Palmer et al, ‘Reducing unnecessary cross-matching: a patient-specific blood ordering system is more accurate in predicting who will receive a blood transfusion than the maximum blood ordering system’, Anesth Analg. 2003 Feb;96(2):369-75. https://pubmed.ncbi.nlm.nih.gov/12538179/
Patient Blood Management Guidelines: Module 2 Perioperative (Recommendations 1 to 3; Practice Points 1 to 3; Section 3.1 and 3.3), National Blood Authority Australia, 2012. https://www.blood.gov.au/pbm-module-2
How this list was made
As part of the Evolve program, the RACP Policy and Advocacy team has worked with the Australian and New Zealand Society of Blood Transfusion (ANZSBT) to develop and finalise this Evolve Top-5 list of low-value care that pertains to the specialty.
Per usual processes, the list of low value practices was first identified by the ANZSBT Council and condensed to the top-5 recommendations, through a membership survey, extensive research and rounds of redrafting under the guidance of the ANZSBT Council. The list was subjected to an extensive review and consultation process that involved RACP-affiliated specialty societies and other key colleges via the Choosing Wisely program. Feedback from the consultation has been integrated into the top-5 recommendations by the ANZSBT and approved by its Council in December 2021.
Version 1 published January 2022.
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1
Do not use peri-operative transfusion for otherwise reversible anaemia prior to elective surgery.
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2
Do not transfuse red blood cells for iron deficiency where there is no haemodynamic instability.
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3
Do not transfuse more units of blood than necessary.
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4
Do not order a group and crossmatch when a group and antibody screen would be appropriate.
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5
Do not transfuse standard doses of fresh frozen plasma to correct a mildly elevated (<1.8) international normalized ratio prior to a procedure.