Pattern of blood ordering, cross matching and utilization in the surgical suites of Kenyatta National Hospital (KNH)

Abstract

This was a 3 months prospective study carried out at KNH on pattern of blood ordering, cross matching and utilization. Patients who satisfied the study criteria were recruited from elective theatre list of surgical suites of KNH that include: general Surgery, orthopaedic surgery. Paediatric surgery, plastic surgery , cardiothoracic surgery and neurosurgery units. The following details were recorded for every patient; age, sex, occupation, religion, level of formal education, duration of illness resulting in admission for surgery, duration of waiting for admission after the patient was booked for elective operation, planned surgery type, patient ABO blood group and Rhesus D status and amount of blood requested for that particular operation . Subsequent follow up of patient's blood request was done at BTU and amount of blood crossmatched and its ABO blood group and Rhesus D for that particular operation were recorded. After the operation, details of blood transfused or not transfused were recorded. Between the third and fifth postoperative day, blood was drawn from the patients and analyzed for haemoglobin, white blood cell count, platelets, sodium and potassium levels.

On discharge of the patients, duration of hospital stay was recorded. Only 119 patients whose age ranged between two weeks and 87 years were studied. The results revealed that:- • The peak age group range was 21 - 30 years (20%) • The male (68) to female 51 ratio was 1.3:1 • The ratio of Christians (107) 51% to Muslims (12) 9:1 • Education level in the study population was in the order of, no formal education 29.4%, Primary 31.9%, Secondary 29.4%, College 9.2% of the study population. • Majority of the study patients (62.2%) were unemployed. Duration of illness that patients waited before seeking medical attention ranged from 0 - 1 0 weeks with a peak duration of > 8 weeks(53%). • Duration of waiting for surgery after diagnosis was made ranged from 0 to greater than 8 weeks. Majority of the patients (72%) waited for 2 weeks or less before being operated on. • Majority of the study patients had ABO Blood group O Rhesus D+ (66.1%) • Majority of the surgical procedures done were in the general surgical unit (28%)followed by orthopaedic surgical unit (24%) • The main cause of rescheduled operations was due to lack of appropriate ABO Rhesus D Blood (96%). • The mean preoperative haemoglobin levels ranged from 11.6- 14.5 g/dl (55%) • Blood transfusion in the elective procedures that were performed in this study were mainly intra operative (88%)

The mean post operative haemoglobin levels for transfused patients and patients not transfused was (11.6 - 14.5) g/dl Elective surgical procedures performed were predominated by craniotomy and excition of brain tumor (10.9%) The crossmatch to transfusion ratio (C/T) was <2.5:1 in 16 (39%) of the elective surgical Proedures done, with 15 (36.6%) as having a transfusion probability (T/P) of >30%. Maximum surgical ordering blood schedule for total hip replacement is one unit of blood. Majority of the blood from BTU to the surgical units were utilized in the cardiothoracic unit (41.4%) Mean duration of hospital stay for transfused patients was 27 days and for not transfused patients 29 days. It is concluded from this study that it is possible to designate MSOBS for elective surgical procedures in KNH.