Blood utilization in elective surgery in a tertiary hospital in Dar es Salaam, Tanzania

Abstract

Background: There has been an observation of blood being unnecessarily requested even for surgeries that will not require transfusion. Furthermore, some patients have been denied surgery due to lack of blood causing surgical list disruptions and inconveniency to patients and their families. This study was carried out to determine the status of blood utilization practices at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.

Methods: A descriptive cross-sectional study was carried out for a period of eight months. Data on blood requisition and usage was collected on a structured questionnaire, and analyzed for Cross-match to Transfusion (C/T) ratio, Transfusion probability (%T), and Transfusion Index (TI). For those procedures that showed more than two indices to be significant, a Maximum Surgical Blood ordering Schedule MSBOS was proposed.

Results: Blood was over ordered for 76% of the patients while over eight percent of the patients had haemoglobin levels over 10g/dl. Only amputation, laparotomy for malignancies, pneumonenctomy, and bowel resection for malignancy had at least two of the transfusion indices showing significant blood utilization for general surgery cases.  For urological cases, only Cystectomy for bladder cancer and nephrectomy had at least two of the indices showing significant blood utilization. In the remaining cases, blood utilization was inefficient suggesting cross-matching of blood was unnecessary, which resulted in loss of nearly 73% of technician’s working hours and USD 425 for the study period.

Conclusion: There is existence of over ordering of blood in this hospital. Blood ordering practices needs to be reviewed to minimize over ordering of blood. All the three indices showed inefficient use of blood in most of the operations. But even so, utilization can still be improved in some of the operations which showed significant utilization.