Appropriate preoperative transfusion requests: an unsolved issue

Abstract

Nearly fifty years after Friedman et al introduced the Maximum Surgical Blood Order Schedule (MSBOS) to optimize preoperative blood ordering, inappropriate transfusion requests remain a widespread issue. Despite strong evidence showing that proper MSBOS implementation reduces blood product wastage, costs, and safety risks without compromising patient outcomes, many institutions continue to overestimate transfusion needs. The recent multicentre study by Contreras-Lopez et al. involving elective brain tumour surgeries in Spain revealed substantial inefficiencies, with over 83% of patients having blood reserved but only 6.6% actually transfused. The findings underscore the persistence of poor compliance with MSBOS principles and limited use of type-and-screen protocols, particularly in low-transfusion-risk procedures. Overordering is often driven by precautionary concerns but leads to unnecessary resource consumption and increased risk of mis-transfusion. To ensure appropriateness, MSBOS protocols must be data-driven, institution-specific, and integrated into hospital-wide quality improvement systems supported by electronic health record (EHR) technology. Continuous education, multidisciplinary collaboration, and the use of computerized crossmatching and remote electronic release systems have proven effective in improving compliance and efficiency. Overall, rationalizing preoperative blood ordering through updated, evidence-based MSBOS programs and proactive anaemia management is essential to enhance patient safety, resource utilization, and transfusion practice sustainability.