BLOOD TRANSFUSION REQUIREMENT AMONG ADULT PATIENTS ADMITTED FOR ELECTIVE SURGERY AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH), ZARIA

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BLOOD TRANSFUSION REQUIREMENT AMONG ADULT PATIENTS ADMITTED FOR ELECTIVE SURGERY AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH), ZARIA

Abstract

BACKGROUND Blood transfusion is often required in the pre-operative, intraoperative and post-operative management of a wide range of surgical conditions and procedures.
OBJECTIVE To determine the blood transfusion requirements among adult elective surgical cases in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria.
METHODOLOGY Using a cross-sectional observational study design with a sample size of 216, adult elective surgical cases seen in the surgical outpatient department were followed up pre-operatively, intra-operatively and postoperatively. The total number of blood transfusions during this period was measured alongside the pre-operative and post-operative packed cell volume, white cell count, reticulocyte count and platelet count. The sampling technique was a non probability method. Data collected was analyzed using a quantitative method and Epi info 2002 version 6.6 statistical software.
RESULTS The total number of patients seen during the study period was 216. There were more males (137, 63.4%) in the study than females (79, 36.6%). The majority of patients seen were more than 50 years of age making up 95 (44%) of the total number of patients. The median age was 45yrs (range=14-90yrs). The total number of patients transfused was 100, only 3 fell below 20 years age group while those over 50 years age group had the majority with 51 patients. Out of the 100 patients that had transfusion, 63% were males while 37% were females. House wives and those unemployed were the highest seen, there were 44 (20.4%) .
Out of the two hundred and sixteen (216) seen in the study, 100 (46.3%) had blood transfusion. The overall crossmatch:transfusion ratio was 1.7:1. That is, out of the 528 crossmatch requests (mean=2.5±0.5; range= 0-8), 307 (58%) transfusions were carried out. There were 142 transfusions pre-operatively (mean=0.6±0.2; range =04), 75 intra-operative transfusions (mean=0.3±0.1; range =0-4) and 90 postoperative transfusions (mean=0.4±0.2; range=0-3). Allogeneic blood transfusion was the predominant type (96, 96%) while only 4 (4%) cases of autologous blood transfusion were recorded.
There was a significant relationship between the average blood loss and the units of blood required for blood transfusion (P value=0.02). The overall mean blood loss was 252mls (range =10-1300mls). For head and neck surgeries the average blood loss was 129mls with a transfusion index of 5.2%, abdominal cases had 422mls and 54.3%, benign tumours had 197mls and 29.4%, malignant tumours had 239mls and 66.7%, ear nose and throat cases had 62mls and 33.3% and general surgery cases had 323mls and 53%.
There was a significant relationship between blood transfusion and the increase in the pack cell volume from the pre-operative to the post-operative periods (P value = 0.02).
CONCLUSION Blood transfusion rate for elective surgery in adults is high. Surgeries involving the abdomen and malignant disorders have a high probability of blood transfusion and hence should be given priority during compatibility tests. There is a need for the constitution of a hospital transfusion committee which will formulate policies regarding maximum surgical blood order schedule (MSBOS) and increase awareness on the need for autologous transfusion and alternatives to blood transfusion.

BLOOD TRANSFUSION REQUIREMENT AMONG ADULT PATIENTS ADMITTED FOR ELECTIVE SURGERY AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH), ZARIA

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