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%) .
14

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.