Ordering Group and Screen (G+S) Pre-operatively

Ordering a Group and Screen is a clinical decision dependent upon a number of factors:

• Patient
• Baseline Haemoglobin level
• Presence of co-morbid disease (e.g. cardiac, respiratory, haematological etc)
• Extent and duration of surgery
• Surgical technique

1. It should be considered when it is likely that the intraoperative Hb level will fall below 7.5g% in an otherwise healthy patient, or below 10g% in a patient with significant cardiac / respiratory disease. Surgery likely to fall into these categories includes cardiac surgery, major thoracic surgery, major vascular surgery, major orthopaedic surgery (corrective spinal surgery, revision arthroplasties and primary lower limb arthroplasties), liver surgery and major oncological surgery with or without reconstruction.

1. Patients who have had previous blood transfusions, are at risk of intra-operative bleeding, need a Group and Screen to detect possible antibodies from the previous transfusion which may make cross-matching difficult.

1. Patients with chronic anaemia (e.g. chronic renal failure) do not need a Group and Screen for surgery where blood loss is unlikely.

1. Where possible, all Group and Screen requests should be ordered during normal working hours.

If a registrar or intern is uncertain about whether to order one for the proposed surgery, the anaesthetic consultant concerned should be asked.