Maximum Surgical Blood Order Schedule (MSBOS)

Like the type and screen, the goal of the MSBOS is to promote efficient use of blood. A typical MSBOS consists of a list of types of surgery correlated to the recommended maximum number of donor units that a physician should order to be crossmatched (see below). To order more blood than is mandated by an MSBOS, the physician needs to have a valid rationale.

Whenever a historical review of blood usage for a type of surgery suggests that blood is seldom required, the MSBOS would recommend that zero units be crossmatched, i.e., a type and screen is all that should be done. To develop an MSBOS, each facility does an historical review of its own blood usage patterns and develop its own unique MSBOS. Using an MSBOS requires that a blood transfusion quality assurance/auditing committee be in place composed of professionals such as staff surgeons, anesthesiologists, and the medical director of the transfusion service.

Table 1 shows a few examples of surgeries correlated to maximum blood requests.

Table 1. Sample MSBOS

Type of Surgery
Transfusion Guidelines
  • cholecystectomy
  • T &S
  • hernia
  • T & S
  • total knee
  • T & S
  • hysterectomy
  • 2 units
  • total hip
  • 5 units
  • aneurysm resection
  • 6 units

Also see the MSBOS used by the blood bank of the University of Michigan Hospitals in the USA and the MSBOS used by the transfusion service at the London Health Sciences Centre in Ontario, Canada. Note that London uses the term "G & R" (group & reserve) as a synonym for type and screen.

Enrichment activity #5

Read the 1994 article, Pretransfusion testing of red blood cells: current status, by Yang O. Huh, MD of the University of Texas M. D. Anderson Cancer Center, Houston, Texas. Based on the information, answer the following questions and e-mail responses to Pat.

  1. This article discusses using an abbreviated crossmatch for patients who lack clinically significant antibodies. By eliminating the IAT crossmatch with donors, how much technologist time may be saved (according to references 1-3, cited by Dr. Huh)?

  2. Dr. Huh notes that pretransfusion testing cannot detect all clinically significant antibodies. Which two circumstances does he give as examples when antibodies may go undetected?

  3. According to a survey by the College of American Pathologists in 1987, which percentage of hospitals were routinely using an IS-XM (without an IAT phase) for patients with negative antibody screens?

  4. For patients without clinically significant antibodies the M. D. Anderson Cancer Center uses an IS crossmatch rather than an electronic crossmatch. Which reason is given for not using the latter?

hotlink Post comments to the class discussion list,  as follows: Why do you think that it has taken so long for blood banks to change from the IAT crossmatch with donors to an IS at RT? Briefly explain two or more reasons. What is your own opinion of using an abbreviated crossmatch for patients without clinically significant antibodies?

Type & Screen MSBOS Assignment 1