Madam, It is true, MSBOS (Maxium Surgical Blood Ordering Schedule) can reduce unnecessary cross matches, resulting in additional cost to the patient as it has been observed in Chawla et al1 study, “An audit of blood crossmatch ordering practices at the Aga Khan University Hospital: first step towards a MSBOS1”. MSBOS is an aim that every efficient blood transfusion services would like to achieve in their hospitals. However, there are two basic prerequisites to strive for efficient MSBOS. First to have a regular screening of blood donors for atypical antibodies. Secondly to have sufficient inventory of safe blood to meet any unusual need of blood transfusion. In Pakistan, most of blood transfusion services are not regularly screening the blood for atypical antibodies and complete procedure of cross, could only offer the protection against the incompatible blood transfusion reactions. Similarly most of the blood transfusion services in Pakistan are managing their services on family blood donor replacement basis. Family blood donors usually donate blood when they are sure that their blood will be used for transfusion to their patient. Their inventory always remains in shortage of safe blood. One blessing in disguise of inefficient MSBOS is that blood arranged, but not used in elective surgical procedures, becomes the source of supply to other patients in emergencies or in cases where patients cannot arrange replacement blood donors. To implement the recommendations of the study, in places where these two prerequisites are not met, can result in a compromise for safety of blood. In all such cases unscreened blood for atypical antibodies could be issued without having a proper crossmatch, or in cases of non availability of safe blood, blood might be taken from unsafe sources of blood.
S. A. Mujeeb
Blood Transfusion Services, Jinnah Postgraduate Medical Center, Karachi.
1.Chawla T, Kakepoto GN, Khan MA. An audit of blood crossmatch ordering practices at the Aga Khan University Hospital: first step towards a maximum surgical blood ordering schedule. J. Pak. Med. Assoc., 2001 ;51:251-54.