The Impact Of A Cash Driven Health Care System On Blood Utilization : An Analysis Of Blood Utilization During Elective Surgeries At The University Of Nigeria Teaching Hospital Ituku-Ozalla- A Pilot Survey

Abstract

One of the tasks of the anaesthetists includes making a decision on the need for blood transfusion during surgical procedure. This task though daunting in the face of epileptic blood supply, will save lives, but may result in over ordering and wasting of blood. AIMS/OBJECTIVES 1 To assess the efficacy of blood ordering practice.2 To assess the feasibility of a prospective random work to develop practice guidelines. MATERIALS AND METHODS: A prospective study involving patients booked for elective surgical procedures who were asked to provide blood for the surgery. The study spanned a period of three months and variables included pre/ post operative haemoglobin level estimation, duration of surgery, blood loss, number of units of blood provided and number of units of blood transfused. Cross-match/transfusion ratio, degree of over/under transfusion, and transfusion index, transfusion probability were calculated. ResultsCross match to transfusion ratio is higher than 2.5: 1 during procedures such as thyroidectomy, cholecystectomy, and myomectomy, elective caesarean section but lower during open prostatectomies, laminectomy and aneurysm surgery . Logistic problems affected post operative haemoglobin estimation but from the few that had their post operative haemoglobin level checked, the patients were under-transfused.Conclusion There is definitely over-ordering of blood which needs to be minimized by changing the blood ordering pattern through the development of a maximum surgical blood ordering schedule. Provision of refrigerators for storing blood in the theatre (theatre mini blood bank) would limit the need for palpable blood in the theatre before it is needed and help in preventing ageing of blood.