Utility of type and screen policy for pretransfusion compatibility testing at an urban level Ι apex trauma center

Objective: Type and crossmatch (TC) policy is the most common approach for pre-transfusion compatibility testing prior to issue of blood for transfusion. As it involves reserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can lead to excessive blood cross matching, inventory management problems, undue workload, blood outdating and reagent wastage. Type and screen (TS) policy is an alternative approach without the need to cross match and reserve blood units prior to issue. The aim of the current study was to retrospectively assess the impact of the implementation of TS policy for pre-transfusion compatibility testing on blood transfusion services at an urban level Ι trauma center. Methods: The study was done in two phases in the Department of Transfusion Medicine at Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data was collected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policy and second phase (Apr 2017-Sept 2017) of TS policy. Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusion probability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stock index (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentage of issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reduction in expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytic transfusion reaction was reported during the study. Conclusion: TS policy was found to be a safe and an efficient alternative approach to TC policy for pre-transfusion compatibility at our center. We recommend the implementation of TS policy, but each center should first assess its feasibility based on patient population, blood bank resources and staff knowledge.