Appendix A: MAXIMUM BLOOD ORDERS

Version July 2004

Appendix A

MAXIMUM BLOOD ORDERS
PROVIDED FOR SURGICAL
PROCEDURES

The following schedule of maximum provision of Red Blood Cells for common operations has been confirmed by the appropriate departmental chairmen and section heads. The Blood Bank will provide no more than the designated amount of Red Blood Cells, although orders for fewer units will be followed. If transfusion is not anticipated, the maximum order is a “type and screen”, and the physician may elect not to send a sample for pretransfusion testing if the patient has previously been evaluated by the Blood Bank.

The provision of blood for procedures not on this list will be based, as in the past, on the order of the surgeon scheduling the case in the operating room. Units of blood for all surgical patients shall be in the form of Red Blood Cells. Whole blood is not generally available.

Should the patient's clinical condition indicate that the volume of blood designated on this list is inadequate, the Blood Bank will provide additional units if notified through consultation with the technologist-in-charge or with the medical staff of the laboratory.

NSR = No Specimen Required T & S = Type and Screen

General and Vascular Surgery	Orthopedic Surgery
Neurosurgery	Plastic Surgery
Otorhinolaryngology	OBSTETRICS-GYNECOLOGY
Cardiac and Thoracic Surgery	UROLOGY

General and Vascular Surgery

Amputation of limb (A/K OR B/K)	T & S	Gastrectomy, subtotal or total, with or without vagotomy	2
Aneurysm, abdominal	4	Gastroplasty, Mason (Gomez)	T & S
Appendectomy	T & S	Gastrostomy	T & S
Breast	NSR	Hemorrhoidectomy	NSR
Biopsy	NSR	Hepatectomy	3
Mastectomy, simple or modified	NSR	Hernia repair, all types	T & S
Mastectomy, radical		Hodgkin’s or Lymphoma staging	T & S
TRAM	2	Laparotomy, exploratory	T & S
Bypass, vascular		Pancreatectomy, partial or radical	3
Aorto-iliac or aorto-femoral	4	Parathyroidectomy	T & S
Femoral-popliteal	2	Parotidectomy	NSR
Carotid endarterectomy	T & S	Pilonidal cyst or sinus resection	NSR
Cholecystectomy, with or without CBDE	T & S	Renal transplant	T & S
Colectomy		Shunt (portal hypertension)	6
Subtotal	2	Skin Graft, split thickness	T & S
Total or abdominal-perineal (AP)	3	Splenectomy	1
Colostomy, revision or closure	T & S	Sympathectomy	T & S
Embolectomy	2	Thyroidectomy	T & S
Endovascular AAA	2	Tracheostomy	T & S
Esophagectomy	4	Vagotomy and pyloroplasty	T & S
		Varicose vein stripping	T & S

Neurosurgery

Aneurysm, cranial	2	Laminectomy, cervical, thoracic or lumbar, for tumor	2
Anterior cervical diskectomy, with or without fusion	T & S	Lumbar or cervical fusion, posterior	2
Carotid endarterectomy	T & S	Lumbar peritoneal shunt	T & S
Carpal tunnel release	NSR	Child	T & S
Cordotomy	T & S	Meningomyelocele repair	T & S
Craniectomy for synostosis (child)	2	Peripheral nerve surgery other than carpal tunnel, tarsal tunnel and ulna nerve transposition	T & S
Craniotomy		Stereotactic brain biopsy	NSR
For AV malformation	6	Syringoperitoneal shunt	T & S
For STA MCA or PICA bypass	2	Child	T & S
For intracranial hematoma	2	Tarsal tunnel release	NSR
For tumor	2	Ulnar nerve transposition	NSR
Hypophysectomy	T & S	Ventriculoarterial shunt	T & S
Laminectomy, lumbar, for disk	T & S	Ventriculoperitoneal shunt	T & S
Laminectomy, cervical, thoracic or lumbar, for decompression	T & S

Otorhinolaryngology

Acoustic tumor resection	T & S	Mastoidectomy, partial or total	NSR
Angiofibroma, resection	2	Maxillectomy	2
Brachial cleft cyst, resection	NSR	Neurovascular reconstruction	T & S
Caldwell-Luc procedure	NSR	Orbital exploration	NSR
Carotid body tumor resection	2	Parotidectomy	NSR
Craniofascial resection	T&S	Pharyngeal flap	T & S
Cleft palate repair	NS	Radical neck dissection	T&S
Ethmoidectomy	NSR	Retrolabyrinthine vestibular nerve resection	T & S
Glomus jugular tumor excision	2	Rhinoplasty	NSR
Laryngectomy Simple	T&S	Temporal bone resection	T & S
with radical neck	T&S	Tonsillectomy-adenoidectomy	NSR
Mandibulectomy, hemi or total	2	Tracheostomy	NSR

Cardiac and Thoracic Surgery

Aneurysm, thoracic, resection	4	Hernia repair,
Atrial septal defect repair	2	All types including primary hiatus	T & S
Arterial switch operation	4	Recurrent hiatus	T&S
Blalock-Tussig Shunt	1	Lobectomy pulmonary	T&S
Coarctation of aorta repair		Patent ductus arteriosus repair	T&S
Child	1	Pericardectomy	2
Adult	2	Pneumonectomy	T&S (modified 5/8/2000)
Coronary bypass graft (CABG)	2	Tetralogy of Fallot Repair	4
CABG Redo	2	Tracheostomy	T & S (modified 5/8/2000)
Embolectomy	2	Valve replacement	2
Esophagectomy	T&S	Ventricular septal defect repair	3
Fontan Procedure	4	Wolf-Parkinson White Procedure	2
		Yag Laser Bronchoscopy	T&S

Orthopedic Surgery

Amputation (A/K OR B/K)	T & S	Hip arthroplasty
Arthrotomy	T & S	First operation	2
Arthroscopy	NSR	Subsequent operations	4
Cervical fusion	2	Hip disarticulation	4
Cervical laminectomy (disk)	T & S	Hip pinning	2
Fracture, open reduction		Knee arthroplasty	T & S
Hip	2	Laminectomy, lumbar	T & S
Femur	2	Meniscectomy	NSR
Tibia	T & S	Osteotomy or bone biopsy
Forearm	T & S	Femur	2
Fusion, lumbar or thoracolumbar	2	Tibia	T & S
Hand surgery	NSR	Removal of knee pin	T & S

Plastic Surgery

Cleft palate repair	NSR
Craniofacial procedure with intracranial comp	2
Mammoplasty
Augmentation	NSR
Reduction	NSR
TRAM	T & S
Anthogerathic procedure with major osteot
Otoplasty	NSR
Rhinoplasty	NSR
Skin flap	T & S

OBSTETRICS-GYNECOLOGY

Abortion, spontaneous, or termination during first or second trimester	NSR	Hysterectomy
Cervical conization	NSR	Vaginal	T & S
Cesarean section		Vaginal with pelvic floor repair	T & S
Uncomplicated	T & S	Abdominal	T & S
Known or suspected placenta previa	2	Abdominal with Salpingo-oophorectomy	T & S
Placenta percreta/accreta	3	Abdominal with Salpingo-oophorectomy	T & S
After trial of forceps	T & S	Radical	4
Cesium implant	NSR	Laparoscopy	NSR
Deliveries, multiple (vaginal or abdominal	T & S	Oophorectomy and ovarian wedge resection	NSR
Delivery accompanied by marked anemia (Hb <10 gms ) or shock	2	Pelvic lymph node dissection	3
Ectopic pregnancy	2	Placenta previa under observation	T & S
Examination under anesthesia (EUA) for known or suspected placenta previa	2	Salpingo-oophorectomy	NSR
High risk labor	T & S	Tubal ligation	NSR
		Tuboplasty	NSR
		Vaginectomy	2
		Vulvectomy, total or radical	2

Urology

Adrenalectomy	2	Prostatectomy
Cystectomy	4	Transurethral	T & S
Cystolithotomy	NSR	Suprapubic	2
Cystoscopy	NSR	Perineal	2
Ileal loop	T & S	Radical	4
Kidney biopsy, open	T & S	Renal artery repair	3
Meatotomy	NSR	Retroperitoneal lymph node dissection	2
Nephrectomy	T & S	TUR (Bladder Tumor)	T & S
Radical Nephrectomy	4	Ureterostomy	T & S
Orchiectomy	NSR	Uretero-vaginal or vesico-vaginal fistula repair	T & S
Penile implant	T & S	Urethroplasty	NSR
		Vesicopexy (ALL)	T & S

Hip

After trial of forceps

Meatotomy