|Year : 2014 | Volume
| Issue : 1 | Page : 19-22
Pattern of blood transfusion request and utilization at a Nigerian University Teaching Hospital
Abubakar U Musa1, Mohammed A Ndakotsu2, Abdul-Aziz Hassan1, Ayatollah Kilishi2, Ibrahim K Kwaifa2
1 Department of Hematology, ABUTH Zaria, Nigeria
2 UDUTH Sokoto, Nigeria
|Date of Web Publication||20-Mar-2014|
Abubakar U Musa
Department of Hematology, ABUTH Zaria
Introduction: Provision of adequate safe blood is challenging in developing countries due to paucity of voluntary blood donors, poor facilities for storage and blood component preparation as well as inappropriate blood ordering and utilization. Appraisal of pattern of blood transfusion requests and utilization helps highlight shortcomings that could be addressed toward judicious use of blood. Aims: To determine the pattern of blood transfusion requests and utilization at a Nigerian Teaching Hospital. Materials and Methods: Blood request forms and cross-match worksheets at the blood bank of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto were analyzed over a 3-month period. Number of blood units requested, cross-matched, or transfused and the cross-match to transfusion ratio (CTR) for clinical units were computed. Results: Of the 1703 units of blood requested for 986 patients, 94.42% (1608) were cross-matched but only 34.51% (555) were transfused giving a CTR of 2.90 for the hospital. The CTR for the various clinical units were: O and G - 3.40, Surgery - 3.11, Trauma center - 2.74, Emergency - 2.61, Medicine - 2.02, and Pediatrics - 1.97. Conclusions: The overall CTR of the hospital is high indicating suboptimal transfusion practice. Introducing transfusion guidelines and type and screen with abbreviated cross-match method can help toward apt requisition and utilization of blood thereby reducing wastages.
Keywords: Blood transfusion, cross-match to transfusion ratio, request, utilization
|How to cite this article:|
Musa AU, Ndakotsu MA, Hassan AA, Kilishi A, Kwaifa IK. Pattern of blood transfusion request and utilization at a Nigerian University Teaching Hospital. Sahel Med J 2014;17:19-22
|How to cite this URL:|
Musa AU, Ndakotsu MA, Hassan AA, Kilishi A, Kwaifa IK. Pattern of blood transfusion request and utilization at a Nigerian University Teaching Hospital. Sahel Med J [serial online] 2014 [cited 2021 May 10];17:19-22. Available from: https://www.smjonline.org/text.asp?2014/17/1/19/129149
| Introduction|| |
Blood transfusion plays vital roles in the medical and surgical practice.  In order to achieve these, blood transfusion has to be appropriate and judicious. Availability of adequate safe blood has been challenging in developing countries due to dearth of voluntary blood donors, poor facilities for storage and blood component preparation as well as inappropriate blood ordering and utilization. ,, Periodic appraisal of transfusion practice may highlight shortcomings that could be addressed toward provision of adequate safe blood or good practice that could be strengthened.
This study was conducted to evaluate the pattern of blood transfusion requests and utilization at a Nigerian Teaching Hospital with the aim of determining transfusion practice.
| Materials and Methods|| |
This was a prospective study conducted at the blood bank of the Department of Hematology, UDUTH Sokoto from June 1 to August 31, 2013. Approval was obtained from the Ethical and Research Committee of UDUTH Sokoto.
The blood request forms and the cross-match worksheets of the blood bank were accessed and the following data for the clinical units (Emergency, Trauma, Pediatrics, Surgery, Obstetric and Gynecology, and Medicine) were extracted. The number of patients for whom requests were made, units requested, units cross-matched, units issued out, units transfused, units returned unutilized, and the reason (s) for non-utilization were generated. Using Microsoft Excel 2010 software, the generated data was analyzed into percentages, CTR (total units cross-matched/total units transfused), and non-usage probability, NUP (total units not transfused/total units requested).
All cross-matched units not collected after 72 hours were considered as not issued out as they were reclaimed into the blood bank and re-crossmatched for other patients. All units issued out and not returned to the blood bank within 24 hours were considered utilized (transfused) as all issued out but unutilized blood units are usually returned to the blood bank for proper storage or disposal.
| Results|| |
A total of 1703 units were requested for 986 patients during the study period. The OandG unit had the highest while Medicine unit had the least with 738 (43.34%) and 107 (6.28%) requests, respectively [Table 1].
|Table 1: Number of patients for whom requests were made, units requested or not transfused and the non-usage probability according to the clinical units|
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About 94.42% (1608) of the requested units were crossmatched while only 41.73% (671) and 34.51% (555) of the crossmatched units were issued out and transfused, respectively. This gave a CTR of 2.90 for the hospital [Table 1] and [Table 2]. The OandG unit had the highest CTR of 3.40 while the Medicine and Pediatrics units had a CTR of about 2 or less as depicted in [Table 2].
|Table 2: Number of units crossmatched, issued out, or transfused and the crossmatch to transfusion ratio according to the clinical units|
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The NUP for the hospital stood at 67.41% as up to 1148 of the 1703 requested units were actually not transfused. The highest NUP was with the OandG unit which recorded 71.95% while the Medicine unit the least with 39.25%. The NUPs for the other clinical units are shown in [Table 1].
A total of 116 accounting for 17.29% of the issued out units (671) were returned to the blood bank unutilized as shown in [Table 2] and [Table 3]. The OandG unit had the highest number of unutilized units with 63 (54.31%) while Pediatrics unit had the least with 2 (1.72%). The major reasons for non-utilization were when issued out units were no longer required for transfusion or when surgical interventions were postponed and these accounted for 83 (71.55%) and 29 (25.00%) of unutilized blood, respectively [Table 3].
|Table 3: Units returned unutilized with reasons for non-utilization according to the clinical units|
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| Discussion|| |
The act of over-requisition of blood without subsequent utilization in clinical practice has been reported by earlier workers. ,, This scenario is typified by a CTR of >2 and NUP of >50%. ,
The overall high CTR recorded in this study is similar to the 2.96 reported by Bashawri in Saudi Arabia.  However, Ebose in Benin and Fasola in Ibadan reported lower CTR values of 2.2 and 0.9, respectively. , The observed differences may be due to the varying levels of availability of blood and indications for blood transfusion considered by the requesting physicians. ,,
Comparable pattern of transfusion practice was observed between the OandG and Surgery units who both had CTR beyond 3, NUP beyond 70%, and together accounted for >80% of the non-utilized units. The study by Ebose recorded the highest CTR in the Surgery unit while the Bashawri study showed both OandG and Surgery units had high CTR. , This may be attributable to premature transfusion requests made by junior doctors which were eventually called off after a review by senior doctors, and postponement of operative procedures arising from improper patient preparation or challenges with the operating theaters. The practice of always having units of blood ready, which may not be transfused eventually, before embarking on any surgical procedure may have also contributed. 
The Medicine unit had the highest consumption of requested blood with a CTR of 1.97 and NUP of 39.25%. This finding may reflect the observed transfusion requirement of patients with chronic kidney disease on dialysis, hemoglobinopathies, malignancies, and chronic bleeding. Furthermore, low incidence of prophylactic use of blood in the aforementioned conditions may have contributed. In contrast, however, OandG unit had the highest consumption of blood in the Fasola and Ebose studies. ,
Though the Pediatric unit had a CTR of about 2, the NUP was unacceptably high meaning a lot of requests ought not to have been made as they were eventually not used. A similarly high NUP of 61.00% for the Pediatrics was reported by Ebose.  However, it is worthy of note that over 95% of the issued out units were utilized and this may be due to the life-saving role that immediate transfusion can offer for the pediatric group with high prevalence of anemia.
The transfusion practice observed at the Emergency and the Trauma units are similar with both units having almost the same high CTR and NUP. This pattern may be explained by the promptness with which blood units are requested for managing emergency cases. A similar pattern of transfusion practice was reported by Ebose at the Accident and Emergency unit. 
Suboptimal transfusion practice characterized by high CTR and NUP as observed in the current report can lead to wastage of blood and unavailability of blood for patients in need as crossmatched blood is usually held in reserve for variable period of time before de-reservation. , This practice has also been associated with increase in workload on blood bank personnel as well as wastage of crossmatch reagents with cost implications to both the patient and blood bank. ,
In the face of poor voluntary blood donor base and dearth of facilities for storage and blood component preparation typical of a developing country like Nigeria, the need for judicious utilization of the few available blood units cannot be over-emphasized.  Formulating and adherence to transfusion guidelines have been shown to reduce unnecessary blood requisition. ,
Other measures with proven improvement in CTR and NUP are maximum surgical blood ordering schedule (MSBOS) and type, screen, save, and abbreviated crossmatch (TSSAC). , The MSBOS specifies the number of blood units to be routinely crossmatched for elective surgical procedures based on retrospective analysis of actual blood usage for these procedures.  The TSSACs entail typing patient's blood for ABO and Rh blood group systems and screening for irregular antibodies.  In the absence of irregular antibodies, no crossmatch is carried out. However, a quick spin crossmatch is conducted when blood is eventually needed.  For patients with irregular antibodies, full crossmatch is performed at the outset with corresponding antigen-free blood. 
| Conclusion|| |
The overall CTR and NUP at UDUTH Sokoto were high, implying non-satisfactory transfusion practice that could potentially lead to wastage of blood and crossmatch reagents as well as increased workload on the blood bank personnel. Formulation and adherence to transfusion guidelines as well as introduction of MSBOS and TSSAC could help improve the transfusion practice in UDUTH Sokoto.
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[Table 1], [Table 2], [Table 3]
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