Pediatric Preoperative Blood Typing Mostly Unneeded

A new study claims that certain pediatric surgeries carry such low risk of serious blood loss that clinicians can forego expensive blood typing and blood stocking before such procedures.

Researchers at the Johns Hopkins Children's Center (Baltimore, MD, USA) conducted a retrospective chart review to determine intraoperative red blood cell (RBC) product utilization for pediatric procedures and costs associated with perioperative testing and ordering. The researchers examined perioperative blood testing and intraoperative transfusion data for 8,620 patients younger than 19 years of age who underwent noncardiac surgery over a 13-month period. The main outcome measure was cost associated with testing for blood products in patients undergoing procedures that had a zero rate of transfusion.

The results showed that blood transfusions were not needed in more than 97% of the pediatric procedures. Of the 8,380 patients for whom a transfusion was unnecessary, 707 underwent preliminary blood typing and 420 of them underwent additional cross-matching. In 10 cases, the preordered blood units reached a temperature that made them unsafe for future use and were thrown away. The total costs for the additional tests and unused blood was nearly USD 60,000. The researchers identified ten surgical procedures that had the highest perioperative blood testing, but no instances of transfusion.

These procedures were colostomy or ileostomy takedown, spinal cord untethering, tunneled catheter placement, laparoscopic Nissen fundoplication, elbow reduction and fixation, lumbar puncture, suboccipital craniectomy, hip arthrogram, percutaneous intravascular central line, and tonsillectomy and adenoidectomy. Calculating the odds that a child would require a blood transfusion against the number of actual transfusions performed, the researchers determined that nearly one-third of children underwent excessive blood testing before their surgeries. The study was published in the December 2013 issue in Pediatric Anesthesia.

“The moral of the story here is that times have changed and we transfuse less than we have in the past, so now we find that quite a few children undergo unnecessary blood-typing and cross-matching before common surgeries,” said senior author pediatric anesthesiologist Eugenie Heitmiller, MD. “Unnecessary preemptive blood-type testing and blood stocking can not only inflate the overall cost of care, but squander vital supplies when any unused blood expires and cannot be restocked for future use.”

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Johns Hopkins Children's Center