An Observational Study On Blood Transfusion Requirements In Patients Undergoing Total Abdominal Hysterectomy /myomectomy For Uterine Fibroids In Kenyatta National Hospital

Abstract

Uterine fibroids are benign monoclonal tumors of the uterine myometrium that often appear during childbearing years. In Kenyan Public hospitals, surgery for Uterine Fibroids is mainly by Total abdominal hysterectomy and Myomectomy. Kenyan County hospitals have infrastructural challenges lacking enough storage facilities for blood and blood products. Therefore they depend on the regional transfusion centres that transport blood to the various centres. Kenyatta National Hospital, which is situated next to the National Blood transfusion centre also, has challenges when it comes to blood transfusion. This is because it is usually affected by acute shortage of blood and blood products that occur from time to time. Also, KNH being one of the 2 main National Referral Hospitals tends to admit a large number of patients requiring emergency blood transfusion. Thus when patients in need for elective surgeries have borderline Haemoglobin levels and there is no available blood on standby in the hospital, surgeries are cancelled and postponed to a later date when blood will be made available. There are however no studies in Kenyatta National Hospital that show the incidence of blood transfusion for TAH and Myomectomies perioperatively. Overall objective: To determine blood transfusion rates in patients undergoing total abdominal hysterectomy or myomectomy for uterine fibroids in Kenyatta National Hospital. Methodology: A prospective observational study was conducted among patients undergoing TAH and myomectomy for uterine fibroids in Kenyatta National Hospital. This was done over a 2 month period with the help of 1 research assistant. Preoperative haemoglobin levels, size of fibroids from the ultrasound reports and /or clinical examination were taken and recorded. Intraoperatively, the estimated blood loss was recorded and 24 hours post-operatively haemoglobin level was taken. The data collected was analysed using computer statistical package for the social sciences (SPSS) version 22. ix Results: The mean age of patients was 41.9 (SD ± 8.8) years, range 22 to 60 years. The modal age group was between 40 and 49 years with 24 (37.5%) patients being in this age group. There were 23 (35.9%) women who had previously lost a pregnancy, and 39 (60.9%) were multiparous. The mean BMI among the patients was 27.7 (SD ± 6.7) and 26 (41.3%) patients were overweight. Of the 64 patients undergoing total abdominal hysterectomy or myomectomy for uterine fibroids 19 were transfused yielding an intraoperative blood transfusion rate of 30% (95% CI 18.9 to 42.4%). No significant association between BMI and Blood transfusion rate. There was a significant association between transfusion rate and ASA classification (p = 0.019). The transfusion rate in patients in ASA II was 44.4%, approximately four times greater (OR 4.0, 95% CI 1.25-12.75) than that in ASA 1 (16.7%). The mean haemoglobin declined by 0.2 units in the 24-hour postoperative period but his change was not statistically significant (p = 0.329). Conclusion: The mean change of Hb in TAH/Myomectomy is 0.5 g/dl thus patients with Hb of 10g/dl and above may proceed with surgery. Thus there have been a number of unnecessary cancellations for patients who have Hb of 10 and above because of lack of blood on standby. The size and number of Fibroids may affect amount of blood loss. Increase in ASA status also is associated with increase in blood loss and other perioperative complications. Recommendations: Need for proper preoperative evaluation of patients scheduled for surgery as this may enable on to predict whether or not the patient will lose a lot of blood intraoperatively. Proper documentation especially on the uterine size will enable a care provider to predict Intraoperative events.