Title : Blood transfusion challenges for one stop perioperative clinic care
Abstract:
The one-stop perioperative clinic is a relatively new practice that enhances more integrated multidisciplinary approach for management of prospective surgical patients in outpatient settings. The main benefits of one-stop clinic are minimizing inpatient admission period therefore hospital-acquired infections, and establishing cost-effective pathway for better preoperative assessment. The surgery categories included in this service are defined per health institution scope of service, available facilities, and patient clinical and medical conditions. Example of such cases are ophthalmology surgery and some of oncology surgery. Even though the perioperative assessment is crucial to avoid surgical complication, the transfusion challenges may be overlooked during the outpatient survey compared to the assessment of other co-morbid disease such as bleeding risk or cardiac diseases. It is a common practice to perform laboratory tests to assess anemia or coagulation status, or ECG or Echocardiography to assess the cardiac status. Concerning blood transfusion, the one-stop perioperative protocol should include a way to assess the estimated surgical blood loss, consideration of alternatives to blood transfusion. However, when protocol does not define or mandate the need to test for presence of red blood cells antibodies, a less-experienced health care practitioner may miss to test for alloantibodies, especially for patients with history of pregnancy or blood transfusion. One of the most challenges noted in this regard is patient having significant Red blood cells alloantibodies discovered in same day of planned surgery and unfortunately the booked surgery cancelled or postponed awaiting blood bank investigate the antibody and find compatible blood.
