Has the knowledge economy a role to play in transfusion medicine?

The history of blood transfusion has been dominated by the search for compatibility for species specificity, the search for how to transfer blood from one individual into another or infuse. Safety has become a major issue since it became clear that blood was not only able to allow mystical miracles to take place but could transmit infectious diseases. The science behind these ideas reflects observation, a thinking and exchange of knowledge and skills, originally documented in reports or case studies of what has happened and was observed, and peer presented - knowledge economy.

Bottlenecks of blood processing in Uganda

AIM

To identify where and why delays occur in Uganda blood banks.

BACKGROUND

The timely provision and supply of safe and efficacious blood components to hospitals depends on sound systems in the processing blood banks. Poorly managed systems lead to apparent blood shortages in hospitals and increase discard rates due to expiry before dispatch.

MATERIALS AND METHODS

We reviewed records of 4126 units of whole blood delivered by the mobile collection teams to a major regional blood bank, in the period 1 March 2009 to 30 June 2009, to ascertain the time intervals between the critical steps in the blood processing chain. This was followed by interviews with staff in two blood banks to establish the causes of process delays.

RESULTS

The average duration between blood collection and final labelling (release from quarantine for final storage) was 15·4 (SD 10·8) days. In timeline, the step between matrix generation and grouping was (median duration 8 days) the longest, whereas grouping to labelling was the shortest (median duration 2 days). Blood expiry had the highest discard rate (0·17%) among the non-transfusion transmissible infection marker causes. A minimally facilitated small staff contributed to the process flaws.

CONCLUSION

A considerable amount of blood does not reach hospitals because of process delays between collection and ultimate dispatch. This is caused by a thin staff working with inadequate materials, out-of-date methods and in an overcrowded environment. Provision of adequate staff and improved financial allocations to the Uganda Blood Transfusion Services will mitigate this situation.

Surgical blood order equation in femoral fracture surgery

AIM

This study aimed at establishing the clinical utility of the surgical blood order equation (SBOE) in patients undergoing femoral fracture surgery.

BACKGROUND

A blood ordering schedule defines the perioperative blood use in elective surgery. It lists the number of units of blood required for each procedure preoperatively.

MATERIALS AND METHODS

A case-control study was performed among homogeneous groups of patients (n = 62 each) undergoing open reduction and internal fixation of femoral fractures. Correct prediction of blood use in the group of patients using the SBOE was compared to the group whose blood orders were made without any guideline.

RESULTS

The surgical blood ordering equation was exactly correct in ordering blood for 46 (74·2%) of 62 patients (cases). The current unaided blood ordering method was exactly correct in ordering blood for 27 (43·5%) of 62 patients (controls). Use of the SBOE resulted in a significantly lower crossmatch-to-transfusion ratio compared to that of the current ordering system (1·5 vs 2·3) and saved the hospital transfusion laboratory 465 US$ of crossmatch and inventory management costs in this cohort of patients.

CONCLUSION

The SBOE is a more accurate and cost-saving tool in predicting blood use. It should replace the current unaided method of ordering for perioperative blood in femoral fracture surgery at Mulago Hospital. However, its introduction to other hospitals should be preceded by more rigorous research to strengthen its external validity.

Blood loss and contributing factors in femoral fracture surgery

BACKGROUND

Substantial blood losses frequently accompany orthopedic procedures.

METHODS

We prospectively noted peri-operative hemoglobin changes in 93 patients undergoing surgery for femoral fracture with an aim of establishing blood loss and related factors.

RESULTS

The mean total blood loss assessed 72 hours after the surgical procedure was 3.31 (SD 1.56) units of whole blood. A multiple regression analysis revealed diathermy use and a simple fracture pattern as significant factors in reducing blood loss (p<0.01).

CONCLUSIONS

Open intramedullary fixation of femur fractures leads to considerable peri-operative blood loss. This is can be reduced by use of diathermy during surgery.