Utilization of Cross-Matched Blood for Elective Hysterectomy in a Tertiary Care Center: A Retrospective Review
Somkiat Aroonpruksakul MD1, Nattaya Raykateeraroj MD1, Kitikhun Phumkokrak MD1, Parichart Permpikul MD2
Affiliation : 1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Department of Transfusion Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the incidence of perioperative blood transfusion in cross-matched patients undergoing elective
hysterectomy at Siriraj Hospital, and to identify the associated risk factors.
Materials and Methods : This is a retrospective chart review of patients undergoing elective hysterectomy from 2013 to
2014. The details of each patient were recorded: demography, American Society of Anesthesiologists [ASA] physical status
class, diagnosis, preoperative hematocrit, route of hysterectomy, and uterine or mass size. Independent sample’s t-test was
used to analyze continuous variables, and the risk factors for blood transfusion were analyzed by using univariate analysis
and multiple logistic regression.
Results : A total of 3,219 patients had elective hysterectomy during study period; 644 cross-matched patients were enrolled
in this study and 144 patients were blood transfused in their perioperative period; of which, the incidence was 22.4% (95%
CI 19.3 to 25.7). From univariate analysis, the significant risk factors for perioperative blood using were the diagnosis
(beyond myoma uteri and gynecologic carcinoma), size of mass (bigger than 5 centimeters), preoperative hematocrit (less
than 35%), ASA class III-IV and vaginal hysterectomy. However, when calculated by using multivariate analysis, the vaginal
hysterectomy was not a significant factor, contrary to the gynecologic carcinoma, which had a significant risk.
Conclusion : In elective hysterectomy cases, the medical team should order cross-matching blood when the patient has the
risks: pre-operative anemia, larger than 5 centimeters mass, ASA class III-IV and diagnosis beyond myoma uteri.
Keywords : Cross-match, Blood utilization, Elective hysterectomy, Perioperative, Blood transfusion risk, ASA
