Utilisation of emergency blood in a cohort of of emergency centres in Cape Town, South Africa

Thesis (MMed)--Stellenbosch University, 2017.ENGLISH SUMMARY : Background: The transfusion of blood and blood products forms an essential part of the resuscitation of patients with acute haemorrhage. Group O blood is stored for this purpose in many emergency facilities and transfused uncrossmatched at physician discretion. Minimal data are at present available to describe this practice, particularly the indications for which emergency blood is transfused and the volume thereof. Objectives: This study aimed to describe the indications for which emergency blood was utilised in selected emergency centres in the Cape Town Metropole. Volumes were also noted. Practice at secondary level emergency centres was compared with the tertiary Groote Schuur Hospital. Methods: A cross-sectional study was carried out at three secondary level emergency centres and a tertiary hospital. Data from all recipients of emergency blood from the emergency centre blood reserve were recorded in study registers over the three month study period. The indications for transfusion, volume of blood in units and location of transfusion were recorded. Indications were described as categorical variables and reflected as proportions. Results: Over the three month study period a total of 329 units of emergency blood were transfused to a total of 210 patients. Haemorrhage as a result of trauma accounted for 39% (n=81) of the cases for which emergency blood was used. This was followed by surgical conditions at 22% (n=47), particularly upper gastrointestinal bleeding 11% (n=24) and perioperative bleeding 8% (n=16) . Medical conditions accounted for 15% (n=31) of the blood, with anaemia, 13% (n=27) the most prevalent, particularly at the secondary level hospitals. Gynaecological conditions required 15% (n=32) of the total, particularly ectopic pregnancy 8% (n=17) . The majority of emergency blood, 77% (n=253) was used in the emergency centres and trauma unit, followed by the operating theatres at 6% (n=21). Conclusion: Trauma was the most frequent indication and accounted for the greatest volume of emergency blood transfused. Upper gastrointestinal bleeding, early pregnancy complications and anaemia were the next most common indications. Perioperative bleeding was the most common reason for emergency blood to be used outside of the emergency centre. Ongoing monitoring of this resource is recommended.AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar