Blood transfusion practices in orthopaedic trauma units at Moi Teaching and Referral Hospital, Eldoret, Kenya

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.