Blood utilization practice in elective orthopaedic surgeries at Muhimbili Orthopedic Institute, Dar-es-salaam.

Abstract

Background: The average requirement of blood and it’s products for a particular elective orthopedic procedure is usually based on subjective anticipation of blood loss rather than an evidence-based estimate. Currently, there is no specific evidence based guidelines for the appropriate amount of blood products to be ordered for specific procedures. Therefore this study aimed to fill the knowledge gap in the effectiveness of blood utilization practice. It is expected to add information on formulating a practical institution based protocol for proper optimizing the use of blood components.

Methodology: A hospital based descriptive study was done at Muhimbili Orthopedic Institute from July 2018 to April 2019 in which patients scheduled for elective orthopaedic surgeries for whom blood was requested were include. Demographic data and blood utilization data was collected which was analyzed using SPSS version 20 . Blood utilization was calculated by the following indices: (i) Crossmatch to transfusion ratio (C/T), (ii) Transfusion probability (T %), (iii) Transfusion index (TI), (iv) Maximum surgical blood ordering schedule (MSBOS).

Results: A total of 286 patients undergoing 27 different types of elective orthopedic surgeries were included in this study. Five hundred and twenty seven units of blood were cross-matched, of which only 224 units (42.5%) of blood were transfused to 146(51%) patients. The overall crossmatch to transfusion ratio(C/T) calculated was 2.4, transfusion index (TI) was 0.8 and transfusion probability (T %) was 51.0%. All these figures were found to be within the optimal range

Conclusion: This study revealed an adequate overall ratio of C/T, T%, and TI blood utilization considerable to significant, except for a few surgeries that showed transfusion above or below-accepted levels. Male patients and patients above 60 years of age had more transfusion rate. The highest proportion of blood transfusion was observed in lower limb surgeries. Knee arthroscopy showed the lowest blood transfusion rate while pelvic and acetabular surgeries showed the highest transfusion rate.

Recommendations: There is a need for formulating and practicing institution-based blood ordering policy to guide clinician regarding blood usage