Evaluation of the blood cross matches practices for peri operative patients at the University Teaching Hospital in Lusaka,Zambia

Abstract

Blood cross-matching for peri-operative patients is an important component in the management of surgical patients undergoing major operations. Depending on the efficiency of the laboratory, blood bank and delivery system within hospitals, different centers practice either cross matching or group and save for selected major operations. At the University Teaching Hospital in Lusaka, Zambia, patients undergoing major operations all get cross matched with at least 2 units. An audit showed 65 elective cases cancelled due to unavailability of blood between January and March 2015 from Phase V (emergency theatre), Phase III (main operating theatre) and D block (children’s theatre) theatres.The general objective was to evaluate the effects of the cross-matches made for patients undergoing major surgical operations at the University Teaching Hospital, Lusaka, Zambia. It was also hoped to help in the developing a protocol on, which major cases need cross-matches. This was a cross-sectional observational study. The number of cross-match units ordered from patients’ files and theatre lists and the actual blood units supplied were noted. Then the number of units transfused within a period of 48 hours (2 days) was also noted.In this study, the target was 865 patients, but 79.4% was done. Of these 436 (63.5%) were males. Age distribution ranged from 19 years old to 69 years old. The modal age range was 36 to 50 years old. The elective cases were 626 which translates into 91.1%. Most of the patients were of stable general condition. These accounted for 618 (89.9%) of all the patients. However only 324 (47.2%) patients had hemoglobin within normal range. Only 14.1 % cross-matches in the elective cases were actually transfused, while in emergency cases 71.8% (107 out 149 cross matches) were transfused.There was a significant difference between the actual transfusions (284) that occur and the cross-matches (1403) that are made for the peri-operative patients at the University Teaching Hospital. 79.8% of the cross matches were not transfused. Of note was a huge number 363 (52.8%) of elective cases that had baseline hemoglobin below the normal range. Keywords: Peri-operative, cross matches, blood transfusion, elective surgery