Blood utilization efficiency using the crossmatch-to-transfusion ratio in preoperative and non-preoperative patients
Keywords:
crossmatch to transfusion ratio, blood transfusion, utilization efficiency, patient blood management, surgical blood orderingAbstract
Inefficiencies in blood procurement remain a challenge in transfusion services, potentially leading to unnecessary resource utilization. However, comparative studies on the efficiency of blood use among preoperative and non-preoperative patients remain limited. This study aims to evaluate and compare the efficiency of blood use using the crossmatch-to-transfusion (C/T) ratio indicator in both patient groups at a regional hospital. This study employed a retrospective analytical design based on secondary data from the hospital's blood bank registry. A total of 16,554 units of blood collected over 20 months were used as the sample, selected through a total sampling approach. Data analysis employed descriptive statistics and the paired samples t-test to identify differences between groups. The results indicated that blood usage in preoperative patients tended to be less efficient, with the majority of C/T ratios exceeding the recommended efficiency threshold. In contrast, the C/T ratios for non-preoperative patients remained consistently within the efficient category. Statistical analysis also confirmed significant and meaningful differences between the two groups. The findings underscore the need to implement evidence-based blood ordering strategies, such as the Maximum Surgical Blood Order Schedule (MSBOS) and type-and-screen protocols, to improve efficiency and optimize transfusion practices in clinical care.
Downloads
References
Al-Riyami, A. Z., Al-Mashani, M., Al-Sabti, A., & Al-Hashmi, S. (2020). Assessment of preoperative blood ordering and utilization for elective surgical procedures. Journal of Applied Hematology, 11(2), 65–70. https://doi.org/10.4103/joah.joah_23_20
Anigbogu, I. O., Muoghalu, E., Madu, A., Nonyelu, C., Okoye, H., Ugwu, A., Duru, A., & Chinedu, E. (2023). Effectiveness of blood utilization across departments in a tertiary health institution. Acta Haematologica Polonica, 54(6), 411–416. https://doi.org/10.5603/ahp.95112
Anwar, S., & Shafi, S. (2018). Blood ordering and utilization patterns for elective surgeries: An audit from a tertiary care hospital. Journal of the College of Physicians and Surgeons Pakistan, 28(6), 461–464. https://doi.org/10.29271/jcpsp.2018.06.461
Berhe, T., Enqueselassie, F., & Gebrehiwot, S. (2019). Evaluation of blood ordering and utilization in elective surgical patients in a tertiary hospital, Addis Ababa, Ethiopia. Pan African Medical Journal, 33, 273. https://doi.org/10.11604/pamj.2019.33.273.18341
Clevenger, B., Mallett, S. V., Klein, A. A., & Richards, T. (2015). Patient blood management to improve outcomes from surgery. BMJ, 350, h393. https://doi.org/10.1136/bmj.h393
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.
Cohn, C. S., Delaney, M., Johnson, S. T., & Katz, L. M. (2020). Technical manual (20th ed.). AABB
Golea, A. M., Maghiar, A., Vicas, M., & Vicas, L. (2022). Efficiency of blood utilization in surgical patients: An audit of the crossmatch-to-transfusion ratio. Journal of Clinical Medicine, 11(15), 4501. https://doi.org/10.3390/jcm11154501
International Society of Blood Transfusion. (2021). Maximum surgical blood ordering schedule (MSBOS). https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/waterford/laboratoryservices/msbos.html
Joon, V., Robins, R. D. L., Haran, H. A., I, S. K., & James, S. (2024). Evaluating the crossmatch-to-transfusion ratio as a tool for analyzing and optimizing blood bank resource utilization: A retrospective observational study. Cureus, 16(9), e69862. https://doi.org/10.7759/cureus.69862
Karaca, B., Namdaroglu, S., Arı, A., & Bağrıaçık, N. (2020). Crossmatch-to-transfusion ratio as a new quality indicator in blood banking. Journal of Hematology & Transfusion, 7(1), 1085. https://www.jscimedcentral.com/public/assets/articles/hematology-7-1085.pdf
Kaur, P., Basu, S., Kaur, G., & Kaur, R. (2013). An analysis of the pattern of blood requisition and utilization in a tertiary care centre. National Journal of Integrated Research in Medicine, 4(2), 123–127. https://doi.org/10.70284/njirm.v4i2.2163
Kementerian Kesehatan Republik Indonesia. (2014). Peraturan Menteri Kesehatan Republik Indonesia Nomor 83 Tahun 2014 tentang Unit Transfusi Darah, Bank Darah Rumah Sakit, dan Jejaring Pelayanan Transfusi Darah. Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2015). Peraturan Menteri Kesehatan Republik Indonesia Nomor 91 Tahun 2015 tentang Standar Pelayanan Transfusi Darah. Kementerian Kesehatan Republik Indonesia.
Kour, S., Yasmeen, I., Jan, A., & Singh, B. (2019). Analysis of cross matching to transfusion ratio of blood components in blood bank SKIMS, Soura: A prospective one year study. International Journal of Research in Medical Sciences, 7(12), 4616. https://doi.org/10.18203/2320-6012.ijrms20195527
Mahar, F. K., Moosajee, D. A., & Yasmeen, S. (2021). Optimization of preoperative blood requisition: An audit of blood ordering and utilization practices. Cureus, 13(7), e16186. https://doi.org/10.7759/cureus.16186
Mahfouz, M. F., Elsayed, M. A., & El-sayed, H. A. N. (2019). Evaluation of crossmatch-to-transfusion ratio in preoperative blood ordering for elective surgery. World Journal of Surgery and Surgical Research, 2, 1157. https://doi.org/10.25107/2637-4625.1157
Mueller, M. M., Van Remoortel, H., Meybohm, P., Aranko, K., Aubron, C., Burger, R., Carson, J. L., Cichutek, K., De Buck, E., Devine, D., & Shander, A. (2019). Patient blood management: Recommendations from the 2018 Frankfurt Consensus Conference. JAMA, 321(10), 983–997. https://doi.org/10.1001/jama.2019.0554
Mulyantari, N. K., & Yasa, I. W. P. S. (2016). Laboratorium pratransfusi update (J. Atmaja, Ed.). Udayana University Press.
Naomi, A., Fairuz, & Hiratna. (2021). Gambaran besar angka cross-match to transfusion ratio (C/T ratio) terhadap jenis penyakit pada pasien yang menerima transfusi darah di RSUD KH. Daud Arif Kuala Tungkal, Kabupaten Tanjung Jabung Barat, Jambi. JOMS, 1(1), 80–86. https://doi.org/10.22437/joms.v1i1.14531
Saraswati, K. D., Utami, M. N., Cahyaningsih, & Wulandari, N. (2019). Crossmatch transfusion ratio as indicators of blood service quality. International Journal of Innovative Science and Research Technology, 4(7), 744–749. https://ijisrt.com/assets/upload/files/IJISRT19JL373.pdf.pdf
Seltman, H. J. (2018). Experimental design and analysis. Carnegie Mellon University. https://doi.org/10.1201/b18362-13
Shander, A., Isbister, J., & Gombotz, H. (2016). Patient blood management: The basic principles. Best Practice & Research Clinical Anaesthesiology, 30(2), 113–124. https://doi.org/10.1016/j.bpa.2016.04.004
Subhaktiyasa, P. G. (2024a). Evaluasi validitas dan reliabilitas instrumen penelitian kuantitatif: Sebuah studi pustaka. Journal of Education Research, 5(4), 5599–5609. https://doi.org/10.37985/jer.v5i4.1747
Subhaktiyasa, P. G. (2024b). Menentukan populasi dan sampel: Pendekatan metodologi penelitian kuantitatif dan kualitatif. Jurnal Ilmiah Profesi Pendidikan, 9(4), 2721–2731. https://doi.org/10.29303/jipp.v9i4.2657
Subhaktiyasa, P. G., Candrawati, S. A. K., Sumaryani, N. P., Sunita, N. W., & Syakur, A. (2025). Penerapan statistik deskriptif: Perspektif kuantitatif dan kualitatif. Emasains: Jurnal Edukasi Matematika dan Sains, 14(1), 96–104. https://doi.org/10.59672/emasains.v14i1.4450
van de Schoot, R., & Miočević, M. (2020). Small sample size solutions: A guide for applied researchers and practitioners. Routledge. https://doi.org/10.4324/9780429273872-9
Vibert, R. J., & Spahn, D. R. (2017). Anemia and patient blood management in hip and knee surgery. Current Opinion in Anesthesiology, 30(1), 123–129. https://doi.org/10.1097/ACO.0000000000000412
World Health Organization. (2021). Educational modules on clinical use of blood. World Health Organization.
World Health Organization. (2024). Guidance on implementing patient blood management to improve global blood health status. World Health Organization. https://iris.who.int/handle/10665/380784
Downloads
Published
Issue
Section
License
Copyright (c) 2026 I Gede Billy Sumantri, Moh. Fairuz Abadi, Lia Cahya Sari (Author)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Manuscript Template 
