Blood transfusion in bimaxillary orthognathic operations: Need for testing of type and screen

Fenner, Matthias; Kessler, Peter; Holst, Stefan; Nkenke, Emeka; Neukam, Friedrich Wilhelm; Holst, Alexandra Ioana

doi:10.1016/j.bjoms.2009.01.023

« Previous Next »British Journal of Oral and Maxillofacial Surgery
Volume 47, Issue 8 , Pages 612-615, December 2009

Blood transfusion in bimaxillary orthognathic operations: Need for testing of type and screen

Matthias Fenner
- Department of Oral & Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany
- Corresponding author. Tel.: +49 9131 8533653; fax: +49 9131 8534219.
Peter Kessler
- Department of Oral & Maxillofacial Surgery, University of Maastricht, Maastrich, Netherlands
Stefan Holst
- Dental Clinic 2, Department of Prosthodontics, University of Erlangen-Nuremberg, Erlangen, Germany
Emeka Nkenke
- Department of Oral & Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany
Friedrich Wilhelm Neukam
- Department of Oral & Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany
Alexandra Ioana Holst
- Dental Clinic 3, Department of Orthodontics, University of Erlangen-Nuremberg, Erlangen, Germany

Accepted 11 January 2009. published online 16 July 2009.

Abstract

We prospectively evaluated the incidence of blood transfusion in 105 consecutively treated patients (45 men and 60 women) having bimaxillary orthognathic operations, to find out whether type and screen testing are adequate in clinical practice.

All patients had Le Fort I osteotomy combined with bilateral sagittal split osteotomy of the ramus. The preoperative routine was restricted to type and screen testing and verification of ABO/Rhesus (Rh) status. Autologous blood donation or routine cross-matching of allogeneic units of blood was not done. Intraoperative haemoglobin concentrations and the need for blood transfusion in patients having bimaxillary osteotomies were recorded in a prospective database.

The mean duration of operation was 196min (range 115–325). The median length of hospital stay was 8 days (range 4–16). The mean (SD) reduction in haemoglobin during operation was 34 (16)g/L in men and 32 (10)g/L in women (p=0.32). No patients had an allogeneic blood transfusion.

We found that type and screen testing and verification of ABO/Rh status seems to be an adequate precaution to manage blood loss. As reflected by the low rate of transfusion in the present study, severe haemorrhage that requires transfusion of allogeneic blood has become the exception rather than the rule in bimaxillary orthognathic operations.

Keywords: Type and screen testing, Transfusion, Bimaxillary orthognathic surgery