|Year : 1999 | Volume
| Issue : 1 | Page : 18-21
Blood transfusion practices - A case study*
P Saxena1, A Banerjee2
1 159, Laxmibai Nagar, New Delhi-110 023, India
2 National Institute of Health and Family Welfare, New Delhi-110 067, India
159, Laxmibai Nagar, New Delhi-110 023
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Saxena P, Banerjee A. Blood transfusion practices - A case study*. Indian J Med Sci 1999;53:18-21
Blood transfusion service is a vital component of the health care services. The service can be broadly divided into two components, namely, blood banking and transfusion. The transfusion component deals with scientific and economic use of blood and its products. The guidelines for the appropriate use of blood have been given by the WHO.  These guidelines recognise the need to reduce prevalence of disorders which require haemotherapy by improving public health measures like proper management of infections, clean water supply, proper waste disposal etc. These promote the use of alternative therapeutic modalities like haematinics and give strict indications for use of blood and its components in various diseases and for surgery. The guidelines encourage close monitoring and critiacl review of blood transfusion practices. One unit of blood (about 300 ml in our country) raises haemoglobin level of the recipient by less than 1 gm/dl. Thus, single unit transfusion is insufficient for any effective use, but this is still being done by many clinicians. A study  from the Institute of Medical Sciences, Srinagar revealed that single unit blood transfusion was done in 35% of the total patients receiving blood transfusion. It is now felt safer to use Autologous Blood Transfusion as an alternative to Homologous Blood Transfusion (HBT) due to the fact that supply of healthy, homologous blood is becoming scarce and the risk of getting dreadful diseases like AIDS and Hepatitis-B transmitted by HBT is increasing. Jolly  has described in detail the definition, history, types, indications, advantages, disadvantages and the process of autologous transfusion in a review article. Very few studies related to blood transfusion practices have been done as yet in a district hospital in our country. Since the district hospital is an important secondary care referral centre for the rural health services where many specialities are functioning and has the demand for blood and its products for transfusion, there` ore, there was a need to study the blood transfusion practices of the treating doctors there.
| ¤ Material and Methods|| |
A descriptive study  was conducted at the regional blood bank, district hospital, Faridabad (Haryana) in northern part of India. The data for the study were collected between June and August, 1995. During this period, blood requisition forms and blood issue registers for the period from 1st January 1992 to 31st December 1994 were studied retrospectively using checklists. Interview of all the treating doctors working in various specialities of the hospital was also done using semi-structured interview schedule.
| ¤ Results|| |
The study revealed that the utilization of whole blood was 90%, 89% and 81 of the total blood units utilized during the three years respectively [Table 1]. In rest of the cases, packed red cell units were obtained from Red Cross blood bank at Delhi (due to absence of facilities for manufacturing blood cell components at the blood bank.) The proportion of single unit blood transfusions out of total transfusions done was 87% during 1992 as well as in 1993 and 89.9% during 1994. Blood was often requested in case of acute haemorrhage due to injuries or internal haemorrhage which could otherwise be treated with plasma expanders. Only homologous blood transfusions were done at the district hospital.
| ¤ Discussion|| |
The use of blood for volume replacement for the management fo patients of acute haemorrhage instead of using plasma expanders like crystalloids and colloids: the frequent use of single unit of blood for transfusion and using whole blood instead of blood components shows that the guidelines for appropriate use of blood as given by the : W.H.O. were not being followed by teh treating doctors of the district hospital. However, their blood transfusion practices can be improved through educational intervention by a transfusion specialist. Soumerai et al.  did a controlled trial to determine whether brief, face to face educational outreach visits can improve the appropriateness of blood product utilization. Proportion of red blood cell transfusions classified as compliant or non complaint with blood transfusion guideline as was measured six months before and six months after an experimental educational intervention by transfusion specialist. Based on analysis of medical records of red blood cell transfusions that occurred six monthe after the intervention, the average proportion of transfusions not in compliance with criteria declined from 0.40 to 0.24 among study surgeons compared with increase from 0.40 to 0.44 among control surgeons. So, they concluded that such educational visits can ,improve the appropriateness and cost effectiveness of blood product use in surgery. In the present study, only homologous blood transfusions were done during during routine surgery. Bhasin et al  have done a prospective study at A.I.I.M.S., New Delhi to induce mass scale pre-deposit autotransfusion in cold neurosurgical operations as well as in planned surgery and to establish the advantages of autotransfusion over homologous transfusion. They found that this process was safe, simple and there were no post-transfusion complications. it eliminated the risk of transfusion transmitted diseases and was cost effective because extensive pre transfusion testing was not required. The recommended that the process merits wide use in routine surgical procedures.
Local preparation and use of blood components should also be encouraged as recommended by Gibbs and Corcoran' in a study of blood transfusion services in the developing countries.
| ¤ Summary|| |
Blood transfusion practices of the treating doctors in a district hospital ,in Haryana were studied through retrospective study of blood bank records for the years 1992 to 1994 and interview of the clinicians of various specialities in the hospital. It was found that utilization of the whole blood was 90%, 89% and 81% respectively of the total blood units utilized during this period. Single unit transfusions out of the total transfusions done were 87% in 1992 and 1993 while these were 89.9% in 1994. Blood was often requested for volume replacement in acute haemorrhage. Only homologous blood transfusions were done at the hospital. This study has highlighted that there is scope for improvement of blood transfusion practices by strictly following the indications for use of blood, promoting the preparation and use of blood components, use of plasma expanders for acute blood loss, avoiding single unit transfusions and promoting the use of autologous blood during routine surgery.
| ¤ Acknowledgment|| |
The authors thank the Director, National Institute of Health and Family Welfare, New Delhi and the Director-General Health Services (Govt. of Haryana), Chandigarh for granting permission to conduct the study.
| ¤ References|| |
|1.||WHO. Guidelines for the appropriate use of blood, WHO/LAB/89, 10, Geneva. WHO publication, 1989, 1-6. |
|2.||Makroo RN. Snglie unit blood transfusion (Letter to editor), National Medical J India 1992;5: 303-304. |
|3.||Jolly JG. Autologous transfusion J Indian Med Assocn 1991:89:318319. |
|4.||Saxena P. Study of functioning of blodd bank services in a district hospital, M.D. (CHA) thesis. New Delhi, National Institute of Health and Family Welfare. 1996. |
|5.||Seumerai SB, Salem-schatz S. Avorn J Casteris CS, Ross Degnan D, Popovsky MA. A controlled. trial of educational outreach to improve blood transfusion practice. J Am Med Assocn 1993:270:961-967. |
|6.||Bhasin R, Mahapatra AK, Banerji AK. Auto transfusion in neuro surgical operations J Indian Med Assocn 1993;191:162-163. |
|7.||Gibbs WN, Corcoran P. Blood safety in developing countries Vox sanguinis 1994:377-381. |
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