Abstract:
Background: Blood transfusion is required in the management of life threatening
orthopaedic trauma hemorrhage. However, this practice is faced with erratic supply,
increasing demand for safe blood and inappropriate transfusions which may expose
patients to transfusion associated risks. Adherence to transfusion guidelines has been
shown to ameliorate these challenges.
Objective: To describe socio-demographic and clinical characteristics and determine
the level of adherence to blood transfusion guidelines and outcomes among transfused
orthopaedic trauma patients at Moi Teaching and Referral Hospital in Eldoret, Kenya.
Methods: A hospital based descriptive cross-sectional study of 132 transfused
orthopedic trauma patients was carried out between March 2019 and January 2020 at
Moi Teaching and Referral Hospital. The patients were recruited by consecutive
sampling method. Data was collected using interviewer administered structured
questionnaire. Continuous data were summarized as median (inter-quartile range) and
categorical data as frequency tables and proportions. Fisher’s Exact Test was used to
assess associations between categorical variables and non-parametric Kruskal-Wallis
Test was used for continuous independent variables. A p value < 0.05 was considered
statistically significant.
Results: Males were 101 (76.5%) and the median age was 36 (IQR 28, 47) years.
Majority of the patients, 95 (72%) were referrals, 64 (48.5%) were unskilled workers
and 64 (48.5%) had primary school level of education. Most of the patients, 105
(79.5%) were injured in road traffic accidents and those who sustained isolated femur
fractures were 62 (47.0%). Of all patients, 61 (46.2%) underwent primary open
reduction and internal fixation. Most patients, 105 (79.5%) and 115 (87.1%) had
normal pulse rate and systolic blood pressure respectively while 77 (58.3%) had
increased respiratory rate. The median pre-transfusion haemoglobin was 8.90 (IQR
7.98, 10.35) g/dl and the commonest blood group was O positive. Majority of the
patients, 127 (96.2%) received packed red blood cells. The proportion adherent to
transfusion guidelines was 16.7% [95% CI: (10.75, 24.14)]. The factors associated
with adherence were pre-transfusion haemoglobin and haematocrit levels, Fisher’s
Exact and Kruskal-Wallis p value being < 0.001. Mild transfusion reactions were
noted in 15 (11.4%) patients.
Conclusion: Most patients were males, transfused with packed red blood cells and
majority of injuries sustained were due to road traffic accidents. The level of
adherence to the institutional transfusion guidelines was low at 16.7%. Factors
associated with transfusion guidelines adherence were pre-transfusion haemoglobin
and haematocrit levels. Few and mild transfusion reactions were noted with no
association with adherence to transfusion guidelines.
Recommendations: Moi Teaching and Referral Hospital Transfusion Committee to
increase transfusion guidelines awareness among clinicians in orthopaedic trauma.
High index of suspicion is necessary for diagnosis of transfusion reactions and
cautions to eradicate these reactions be put in place.