Maximum surgical blood ordering schedule (MSBOS)

The purpose of this guideline is to provide guidance about MSBOS at Great Ormond Street Hospital.

Introduction
The MSBOS is a table of elective surgical procedures which lists the number of units of red cells routinely crossmatched for them pre-operatively (British Committee for Standards in Haematology Blood Transfusion Task Force 1990). It allows the more efficient use of blood stocks and reduces wastage. The trust procedure guideline, Blood product transfusion: red cell products provides guidance on the administration of red cells. The guidelines are not rigid and allow for flexibility in certain circumstances. In individual cases, it may be necessary to vary from the suggested requirements on the advice of the responsible consultant. In this instance contact the Blood Transfusion department, extension 8527, or the biomedical scientist on-call outside normal hours, bleep 0590, to discuss your request.

In the event of blood shortages

Provision of red cells will be dependent on availability of normal supplies from the National Health Service Blood and Transplant (NHSBT). In the event of a national shortage, the GOSH Emergency Blood Management Plan will be followed. The plan has been developed to ensure the effective use of blood and blood products at all times, but especially when national stocks have fallen to low levels. The plan can be found online on the GOSH intranet.

Cardiac and cardiac angiography

Maximum surgical blood ordering schedule for cardiac and cardiac angiography No of units/volume Coagulation Group & (mls) screen Procedure save/Crossmatch (G&S/XM) All closed operations XM 1 No

Maximum surgical blood ordering schedule for cardiac and cardiac angiography No of units/volume Coagulation Group & (mls) screen Procedure save/Crossmatch (G&S/XM) All open operations

XM XM + platelets

Yes

under 5kg

3+ platelets (20mls/kg) Yes 3 1 Yes No

All re-do operations XM Aortic balloon (under XM one year) Catheter - pre-op and diagnosic

over 5kg under 5kg

G&S XM No G&S required XM XM XM XM G&S XM XM

None 1 None 1 1 1 1 None 1 1

No No No No Yes No No No No No

Chest drain Closure of fenestration and dilation stent PDA PV balloon (under one month) PV implants RPV Stents VSD

Craniofacial
Maximum surgical blood ordering schedule for craniofacial No of units/volume Group & (mls) Coagulation Procedure save/Crossmatch screen (G&S/XM) Augmentation procedure via bicoronal XM flap Bipartition Under 40kg Over 40kg XM + platelets XM + platelets 2 No

6 + 1 unit platelets 10 + 1 unit platelets

No No

Maximum surgical blood ordering schedule for craniofacial No of units/volume Group & (mls) Coagulation Procedure save/Crossmatch screen (G&S/XM) Calvarial bone grafting XM Calvarial remodelling XM FrontoOrbital XM 3 3 3 2 3 No No No No No

Implant procedure via XM bicoronal flap LeFort I XM LeFort II or III

under 40kg over 40kg

XM + platelets

6 + 1 unit platelets 10 + 1 unit platelets 2

No No No

XM + platelets Mandibular distraction XM Monobloc

under 40kg over 40kg

XM + platelets XM + platelets

6 + 1 unit platelets 10 + 1 unit platelets 2 None 3

No No No No No

Remodelling procedure XM via bicoronal flap Vascular Discuss with malformations SpR/Fellow Vault expansion XM

Ear, Nose and Throat (ENT)

Maximum surgical blood ordering schedule for Ear, Nose and Throat No of units/volume Coagulation Group & (mls) screen Procedure save/Crossmatch (G&S/XM) No general requirements for Xmatching in ENT surgery, although None homozygous sickle +ve children may need blood for adenotonsillectomy

None

None

General and neonatal

Maximum surgical blood ordering schedule for general and neonatal surgery No of Coagulation Group & units/volume (mls) screen Procedure save/Crossmatch (G&S/XM) Adrenal tumour Aortopexy Central venous catheter

XM XM

1 1

No No

over 3kg under 3kg

G&S

None 1 1 1 1 1 1 None None None 1 1 None None 1 1 1 1 2 unit/10kg None 1 1

No No No No No No No No No No No No No No No No No No Yes No Yes Yes No

XM Closure of ileostomy XM Colostomy closure XM Cystic hygroma XM Diaphragmatic hernia XM Duplication cyst XM Duodenal atresia G&S Exomphalos (small) G&S Formation of G&S colostomy Gastric/colonic XM interposition Gastroschisis and XM exomphalos major Gastrostomy G&S percutaneous Gastrostomy - open G&S Intussuseption XM Laparotomy XM Neonatal exploratory laparotomy Liver biopsy Liver resection Malrotation (elective) Necrotising enterocolitis Neuroblastoma Nissen fundoplication XM XM XM G&S XM XM G&S

Maximum surgical blood ordering schedule for general and neonatal surgery No of Coagulation Group & units/volume (mls) screen Procedure save/Crossmatch (G&S/XM)

re-do

XM XM XM G&S XM G&S XM G&S XM XM XM XM

1 1 1 None 1 None 1 None 1 1 1 1

No No No No No No No No No No No No

Oesophageal atresia (primary repair) Pancreatectomy PICC line insertion PSARP PSARP minimal (low lesion) Pull through procedure for Hurschprungs Pyloric stenosis Sacrococcygeal teratoma Spina bifida Splenectomy Volvulus

Interventional radiology
Maximum surgical blood ordering schedule for interventional radiology No of units/volume Coagulation Group & (mls) screen Procedure save/Crossmatch (G&S/XM) Angioplasty CV catheter Liver biopsy Renal biopsy XM No G&S required XM G&S 1 None 1 None Yes No Yes Yes

Neurosurgery
Maximum surgical blood ordering schedule for neurosurgery

Procedure

Group & save/Crossmatch (G&S/XM) 3 1

No of units/volume (mls)

Coagulation screen

Choroid plexus XM papilloma Craniotomy including XM posterior fossa Epilepsy grid G&S except Sturge Weber XM EVD insertion Hemispherectomy Temporal lobectomy for epilepsy IC-EC bypass Spinal tumour

No No No No No No No No

None 1 None 2 None None

G&S XM G&S G&S

under 30kg over

XM XM XM

2 4 1 None 1 None

No No No No No No

Spines under 10kg Other neurosurgical spines (including spinal G&S chord untethering) V-P shunt under 5kg XM or Hb under 10g/dl Other V-P shunt (including endoscopic G&S procedures)

Orthopaedics
Maximum surgical blood ordering schedule for orthopaedics No of units/volume Coagulation Group & (mls) screen Procedure save/Crossmatch (G&S/XM) Dressing change Femoral osteotomy Hip reconstruction Ilizarov No G&S required G&S XM No G&S required None None 2 None No No No No

Maximum surgical blood ordering schedule for orthopaedics No of units/volume Coagulation Group & (mls) screen Procedure save/Crossmatch (G&S/XM) Open reduction of hip Pelvic osteomies (DHH) Shelf procedure Spine: under 12kg Adolescent idiopathic posterior only Spine: neuromuscular

G&S XM G&S XM G&S

None 1 None 2 None

No No No No No

under 40kg over 40kg

XM + platelets XM + platelets

6 + 1 unit platelets 10 + 1 unit platelets

No No

Spine: all other major procedures. If in doubt ask anaesthetist

XM

No

Plastic
Maximum surgical blood ordering schedule for plastic No of units/volume Coagulation Group & (mls) screen save/Crossmatch (G&S/XM) None None None 1 No No No No

Procedure

Bilateral cleft lip repair G&S Cleft lip repair No G&S Cleft palate repair G&S Pharyngoplasty XM

Thoracic
Maximum surgical blood ordering schedule for thoracic

Procedure

Group & Save / Crossmatch (G&S/XM)

No of units / volume(mls)

Coagulation screen

Nuss procedure Open thorax Thoracoscopy

XM XM XM

1 1 1

No No No

Urology
Maximum surgical blood ordering schedule for urology No of units/volume Coagulation Group & (mls) screen save/Crossmatch (G&S/XM) None None None 1 1 1 None 1 None None 2 None No No No No No No No No No No No No

Procedure

See under intervention radiography AV fistula creation G&S AV fistula revision G&S Bladder augmentation XM Bladder neck XM reconstruction Cloaca XM Epispadias G&S Exstrophy XM Hypospadias (complex) G&S Ileo-vaginoplasty G&S Kelly procedure XM Mitrofanoff G&S Nephrectomy laprascopic Angioplasty

unilateral bilateral

G&S XM

None 1

No No

Nephrectomy - open

native kidney transplant

XM

No

XM Nephrostomy insertion G&S Osteomies XM

3 None 1

No Yes No

Procedure

Maximum surgical blood ordering schedule for urology No of units/volume Coagulation Group & (mls) screen save/Crossmatch (G&S/XM) G&S G&S G&S G&S if other blood being taken G&S if other blood being taken None None None None None No No No No No

PCNL PD catheter insertion Permcath insertion Pyeloplasty Reimplant Renal transplant

under five years XM over five years XM Tumour nephrectomy XM Vascath insertion G&S Wilm's XM Other tumour XM

2 4 1 None 1 1

Yes

No No No Yes

Blood Transfusion Committee : Revised May 2011

References
Reference 1: British Committee for Standards in Haematology Blood Transfusion Task Force (1990) Guidelines for implementation of a maximun surgical blood order schedule. Cinical and Laboratory Haematology 12: 321-327. Reference 2: Lewis KA, Engle W, Hainline BE, Johnson N, Corkins M, Eugster EA (2011) Neonatal graves' disease associated with severe metabolic abnormalities. Pediatrics 128 (1): e232-6.