Time to Cross off Routine Preoperative Blood Crossmatch in Mastectomy

Purpose: Blood transfusion in breast cancer surgery patients is now quite rare as surgical haemostatic techniques have become very meticulous. In our hospital, all patients planned for mastectomy have a routine blood cross match done preoperatively. The cost of this blood cross match comes down as about 10 United States dollars (USD) per patient. In this study, we looked at our mastectomy patients who required blood transfusion. Methods: All mastectomy patients from January 2016 to June 2016 were included in our study. The data was derived from a prospectively maintained computerized database. Patient demographics, preoperative and postoperative haemoglobin levels, reasons and timings of blood transfusion were recorded. Results: 182 patients had mastectomy during 6 months. 170 (93.4%) patients had preoperative blood crossmatch done. 15 patients (8.2%) required blood transfusion preoperatively. This was primarily for building up their haemoglobin levels (range 7.4-9.9 g/dL, mean 9.1 g/dL). 9 out of 15 of these patients underwent neoadjuvant chemotherapy. Cost of blood crossmatch in these 15 patients needing transfusion was 150 USD compared to 1700 USD cost of cross matching all 170 patients. None of our patients required transfusion intra or post-operatively. Cost of blood crossmatch in 155 patients that never required blood transfusion was 1550 USD. Conclusion: None of our mastectomy patients required blood transfusion in an emergency situation. 8.2% patients needed transfusion preoperatively, where there was ample time to crossmatch and arrange blood. We recommend that routine preoperative crossmatch in mastectomy patients can be safely avoided (with an additional benefit of saving cost 1550 USD over 6 months).