Nusantara Medical Science Journal 4 (2016) 143-145
ESTIMATED BLOOD LOSS IN CRANIOTOMY
Diana Sitohang, Rachmawati AM, Mansyur Arif
Department of Clinical Pathology, Medical Faculty Hasanuddin University, Makassar
Corresponding Author:
Diana Sitohang
Dept. Ilmu Patologi Klinik, Fakultas Kedokteran, Universitas Hasanuddin, Makassar, 90245
Email: diana.sito@gmail.com
ABSTRACT
Introduction: Estimated blood loss is an estimation of how much blood is loss during surgery.
Surgical procedure requires a preparation of blood stock, but the demand for blood often larger
than the actual blood used. This predicament happens because there is no blood requirement
protocol being used. This study aims to determine the estimated blood loss during craniotomy
procedure and it’s conformity to blood units ordered for craniotomy procedure. Methods: This
study is a retrospective study using data from Wahidin Sudirohusodo General Hospitals’ medi-
cal records in the period of January 2010-December 2012. We found 89 craniotomy patients
that meet the inclusion criteria comprise of 66 men and 23 women. Results: This study showed
that the average estimated blood loss in craniotomy was 3.20 units of whole blood (1120 ml)
and the average of the demand of blood ordered was 4.0 units of whole blood (1400 ml). There
was no mismatch between the amount of blood ordered for surgery and estimation of blood
loss (p=0.73). Conclusion: Estimated blood loss in craniotomy procedure in Wahidin
Sudirohusodo hospital, Makassar is 3.20 units of whole blood (1120 ml) was in accordance
with amount of blood ordered for surgery.
Keywords: Estimated blood loss, craniotomy
INTRODUCTION Ideally a blood request protocol is cre-
ated based on historical data on the use of
Estimated blood loss is an estimate of blood on the institution, considering that
blood loss that occurs during surgery. Surgi- there’s a large number of blood requests pro-
cal procedures often require the provision of tocol within the past 30 years. The Wahidin
a blood transfusion, but the demand for blood Sudirohusodo General Hospital in Makassar
transfusions is often carried out excessively at the present does not yet have a blood
without proper demand analysis. The amount request protocol, thus the amount of blood
of blood loss in a surgery varies depending prepared for surgery is based on “habit” or
on the type of surgery, the surgeon’s exper- experience of the clinician. Data from Wahidin
tise and the patient’s condition. Estimation of Sudirohusodo General Hospital’s blood bank
blood loss is important to determine the on blood usage were as follows: In 2010, 38%
amount of blood demand prepared for surgery ordered blood units were canceled, 58% were
operations which will reduce the amount of returned; in 2011 , 31% blood units ordered
wasted blood. 1-4 were canceled, 36% were returned; and in
Blood transfusion is the administration of 2012, 32% blood units ordered were then
blood or blood components directly into the canceled, and 40.9% were returned. The high
patient’s circulation which is mostly given to percentage of canceled and returned blood
treat anemia, increase blood volume, or improve units showed the ineffectiveness use of blood
immunity. The use of proper blood and blood transfusions. Canceled blood is the blood that
components is needed to ensure the availabil- had been prepared for the surgery but was
ity of blood and avoid the risk of exposure to not distributed; while the returned blood is the
diseases that can be transmitted by transfu- blood that has been distributed in preparation
sion. 1,5 for surgery, but has returned because it was
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Sitohang et al / Estimated Blood Loss in Craniotomy
not transfused. Both of these types of blood blood tests that were tested 6-72 hours after
cannot be used on another patient so it increases surgery. Hemoglobin is tested using a hema-
the operational costs of the blood bank in tology analyzer Sysmex XT - 2000i. All data
terms of storage and cross-matching test pro- obtained are grouped and analyzed using
cedure that had been carried out 6-8 statistical methods are then presented in tabu-
One of the surgical procedures that re- lar form.
quires blood preparation is craniotomy. The
craniotomy is a surgical procedure of the head
RESULTS
by partially opening the skull. This procedure
is usually carried out on some forms of neu- Sample Characteristics
rological diseases, trauma and skull fractures. Based on the data from Wahidin
An accurate assessment of the amount of Sudirohusodo General Hospital’s medical
blood loss is important in terms of maintaining records, in the period of 2010-2012. There
the flow of oxygen to the brain. 6,9,10 were 89 samples of patients undergoing
The preparation of blood transfusions for craniotomy with age range of 15-70 years
a surgical procedure is excessive, in the terms which comprise of 66 men (74.16%) and 23
that the use of blood that has been cross- women (25.84%) (Table 1).
matched is only 23.14%, while 76.86% is not
Table 1. Sample Characteristic
reusable.2,3,8 To the best of the author’s
knowledge, until now, there is no study carried Sex Variable n=89 %
out the estimation of the loss of blood trans- Male 21 74,16
fusion in craniotomy surgery.
Female 23 25,84
The purpose of this research is to deter-
mine the estimated blood loss in craniotomy Estimated blood loss in craniotomy
surgery that will improve the efficiency of blood
request. The result of the research is expected Patients undergoing craniotomy surgery
to become a new reference in the demand for that requires blood in preparation for surgery
blood for craniotomy and add scientific infor- was as many as 89 patients with average
mation about the estimated blood loss in blood demand of 2.89±1.03 bags of whole
craniotomy. blood. Based on blood loss estimation formula
resulted in an average of 3.29±1.77 bags of
whole blood (Table 2).
METHODS There was no significant statistical dif-
ference between the number of blood units
This study was conducted retrospectively
demanded with the estimated blood loss in
by taking the data from Wahidin Sudirohusodo’s
craniotomy surgery (p=0.293). This shows that
Medical Record Installation, in the of period
the amount of blood prepared for craniotomy
2010-2012. The sample population consists
requested in Wahidin Sudirohusodo General
of 1293 patients who underwent the cran-
Hospital, Makassar were in accordance with
iotomy. The number of samples that met the
the estimated blood loss. Utilization of blood
inclusion criteria as many as 89 patients. In-
for the preparation of the craniotomy surgery
clusion criteria for this study: the comprehen- was efficient.
siveness of the data from the medical records, The ability of the surgeons and the con-
suffering intracerebral hemorrhage trauma dition of the patients during craniotomy pro-
without other trauma, pre- and post-operative cedure influenced the amount of blood loss.
examination of Hb. Operators who master the use of tools such
Estimated blood loss is the approximate as electrocautery and the use of crystalloid or
amount of blood loss after craniotomy surgery, colloid fluids to replace blood loss will help
calculated by the formula : minimize the amount of blood loss so the need
Estimated blood loss = for blood preparation can be reduced.
Hb(pre-op) - Hb(post-op) + blood transfusion unit used during surgery Limitations of this study are incomplete
(1 unit of blood is equivalent to 1 g / dl ) medical record data, and the number of pa-
Hb (pre-op) is the hemoglobin of routine tients underwent craniotomy but was accompa-
blood tests were tested before surgery, nied by multiple fractures lead to difficulties to
whereas Hb(post-op) is hemoglobin of routine obtain more samples.
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Nusantara Medical Science Journal 4 (2016) 143-145
Table 2. Estimated blood loss during craniotomy surgery
Craniotomy surgery N Mean r* p*
Blood request 89 2,89±1,03
0,113 0,293
Estimated blood loss 89 3,29±1,77
*Pearson’s correlation analysis
DISCUSSION standard operational procedures in request-
ing the amount of blood for each type of op-
This study shows that the amount of
eration conducted.
blood demand for the preparation of surgery
and the estimated blood loss in craniotomy
surgery in Wahidin Sudirohusodo General CONCLUSION
Hospital, Makassar were appropriate where
the number of operational preparation blood Estimated blood loss in craniotomy pro-
demand of estimate blood loss in surgery of cedure in Wahidin Sudirohusodo hospital,
craniotomy was 1.52 to 5.06 bags of whole Makassar was in accordance with amount of
blood (2-5 bags). It is suggested to make the blood ordered for surgery.
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