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 ¤  Material and Methods
 ¤  Results
 ¤  Discussion
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ORIGINAL CONTRIBUTION
Year : 1999  |  Volume : 53  |  Issue : 1  |  Page : 18-21
 

Blood transfusion practices - A case study*


1 159, Laxmibai Nagar, New Delhi-110 023, India
2 National Institute of Health and Family Welfare, New Delhi-110 067, India

Correspondence Address:
P Saxena
159, Laxmibai Nagar, New Delhi-110 023
India
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PMID: 10798020

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How to cite this article:
Saxena P, Banerjee A. Blood transfusion practices - A case study*. Indian J Med Sci 1999;53:18-21

How to cite this URL:
Saxena P, Banerjee A. Blood transfusion practices - A case study*. Indian J Med Sci [serial online] 1999 [cited 2014 Jul 24];53:18-21. Available from: http://www.indianjmedsci.org/text.asp?1999/53/1/18/12200


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. [1] 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 [2] 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 [3] 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 Top


A descriptive study [4] 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 Top


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 Top


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. [5] 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 [6] 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 Top


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 Top


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.[7]

 
 ¤ References Top

1.WHO. Guidelines for the appro­priate use of blood, WHO/LAB/89, 10, Geneva. WHO publication, 1989, 1-6.  Back to cited text no. 1    
2.Makroo RN. Snglie unit blood transfusion (Letter to editor), National Medical J India 1992;5: 303-304.  Back to cited text no. 2    
3.Jolly JG. Autologous transfusion J Indian Med Assocn 1991:89:318­319.  Back to cited text no. 3    
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.  Back to cited text no. 4    
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.  Back to cited text no. 5    
6.Bhasin R, Mahapatra AK, Banerji AK. Auto transfusion in neuro sur­gical operations J Indian Med Assocn 1993;191:162-163.  Back to cited text no. 6    
7.Gibbs WN, Corcoran P. Blood safety in developing countries Vox sangui­nis 1994:377-381.  Back to cited text no. 7    



 
 
    Tables

  [Table 1]

This article has been cited by
1 Transfusion medicine in India: a survey of current practice
Bray TJ, Salil P, Weiss HA, et al.
TRANSFUSION MEDICINE. 2003; 13 (1): 17-23
[Pubmed]



 

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