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Utilisation of blood and blood products during open heart surgery in a low-income country: our local experience in 3 years

Published online by Cambridge University Press:  02 August 2018

Ikechukwu A. Nwafor ,
Onyinyechukwu A. Arua ,
John C. Eze ,
Ndubueze Ezemba  and
Maureen N. Nwafor
Ikechukwu A. Nwafor*
Affiliation:
Department of Surgery, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
Onyinyechukwu A. Arua
Affiliation:
Cardiothoracic surgery unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
John C. Eze
Affiliation:
Department of Surgery, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
Ndubueze Ezemba
Affiliation:
Department of Surgery, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
Maureen N. Nwafor
Affiliation:
ICU pharmacy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
*
Author for correspondence: I. A. Nwafor, Department of Surgery, Faculty of Medical Sciences, University of Nigeria, Ituku/Ozalla Campus, Nsukka, Enugu 40000, Nigeria. Tel: +2348037784860; +2348034893978;E-mail: igbochinanya2@yahoo.com
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Abstract

Background

In Nigeria, access to open heart surgery (OHS) is adversely affected by insufficient blood and blood products, including the challenges because of the lack of patient-focused blood management strategies owing to the absent requisite point-of-care tests in the operating theatre (OR)/ICU. In addition, the limited availability of altruistic blood donors including the detection of transfusion transmitted infections more commonly among non-altruistic blood donors is another burden affecting the management of excessive bleeding during and after open heart surgery in our country.

Objective

The objective of this study was to review our local experience in the use of blood and blood products during open heart surgery and compare the same with the literature.

Materials and methods

In a period of 3 years (March, 2013–February, 2016), we performed a retrospective review of those who had open heart surgery in our institution. The data were obtained from our hospital health information technology department. The data comprised demography, types of operative procedures and units of blood and blood products transfused per procedure, including the details regarding the usage of the cell saver, as well as those who had severe bleeding requiring excessive blood transfusion.

Results

During the study period, 102 patients had open heart surgery, an average of 34 cases in a year. Among them, there were 75 (73.53%) males and 37 (36.27%) females, giving a ratio of 2:1. The ages of the patients were from 0.6 (7/12) to 74 years. Mitral valve procedure was the most common (n=22, 21.6%) surgery type. Transfusion requirements averaged 1.9 units of fresh frozen plasma, 0.36 units of platelet concentrate, and 1.68 units of packed cells per procedure. The least common surgical procedure was common atrium repair (n=1, 0.01%).

Conclusion

Open heart procedure is a very complex procedure requiring cardiopulmonary bypass with associated severe perioperative bleeding. The attendant blood loss and haemostatic challenges are combated by intricate and selective transfusions of allogeneic blood and or blood products.

Keywords

Surgeryheartperioperativebloodaphaeresis
Type
Review Article
Information
Cardiology in the Young , Volume 28 , Issue 11 , November 2018 , pp. 1289 - 1294
Copyright
© Cambridge University Press 2018 

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References

1. Hussain, BS, Reddy, SV, Prasad, LN, Madhavi, G. Autologous blood transfusion in open heart surgeries under cardiopulmonary bypass-clinical appraisal. J Med Allied Sci 2017; 7: 48–54.Google Scholar
2. Engoren, MC, Habib, RH, Zacharias, A, Schwann, TA, Rioderdan, CJ, Durham, SJ. Effect of blood transfusion on long term survival after cardiac operation. Ann Thorac Surg 2002; 74: 1180–1186.Google Scholar
3. Teker, ME, Cinar, IB. An alternative method that reduces homologous blood use in open heart surgery; cell saver. Cardiovasc Syst 2017; 5: 1.Google Scholar
4. Graves, EJ. National hospital discharge survey: annual summary, 1991. Vital Health Stat 1993; 13: 1–62.Google Scholar
5. Goodnough, LT. Blood and blood conservation: a national perspective. J Cardiothorac Vasc Anesth 2004; 18 (Suppl 4): 6S–11S.Google Scholar
6. Korukcu, A, Karabulut, H, Tosun, R, et al. Effect of remaining venous reservoir blood administration on transfusion in open heart surgery. Turk Kardiyol Dern Ars 1996; 24: 540–544.Google Scholar
7. Kaplan, JA, Canarella, C, Jones, EL, Kutner, MH, Hatcher, CR Jr, Dunbar, RW. Autologous blood transfusion during cardiac surgery. A re-evaluation of 3 methods. J Thorac Cardiovasc Surg 1977; 74: 4–10.Google Scholar
8. Speiss, BD. Transfusion and outcome in heart surgery. Ann Thorac Surg 2002; 74: 986–987.Google Scholar
9. Erhabor, O. Challenges of blood transfusion services delivery in sub-Saharan Africa. 2nd International Conference on Haematology and Blood Disorders, Baltimore, September–October, 2014.Google Scholar
10. Arobieke, O, Osafehinti, S, Ouwajiobi, F, Oni, O. Electrical power outage in Nigeria. History, causes and solutions. J Energy Technol Policy 2012; 2: 1–7.Google Scholar
11. Falase, B, Sanusi, M, Majekondunmi, A, Ajose, I, Idowu, A, Oke, D. The cost of open heart surgery in Nigeria. Pan Afr Med J 2013; 14: 61.Google Scholar
12. Burgster, EA, Winters, JL. Aphaeresis: principles and technology of hemipharesis in Rossi’s principles of transfusion medicine. In Simon TL, McCullough J, Snyder EL, Solheim BG, Trauss RGS (eds). John Wiley & Sons, Ltd, Chichester, West Sussex, 2016, https://doi.org/10.1002/9781119013020.ch32 Google Scholar
13. Wee, MY, Thomas, D, Jones, J, Catling, S, Howard, F, Milton, S. AAGBI Safety Guideline: Blood Transfusion and the Anaethetist Intraoperative Cell Salvage. Association of Anaesthetist of Great Britain and Ireland, London, 2009.Google Scholar
14. Bowley, DM, Barker, P, Boffard, ND. Intraoperative blood salvage in penetrating abdominal trauma, a randomized controlled trial. World J Surg 2006; 30: 1074–1080.Google Scholar
15. Nwafor, IA, Eze, JC, Anyanwu, CH, Ezemba, N, et al. The scope of cardiac surgery at National Cardiothoracic Center of Excellence, in Nigeria; a 3-year review. J Vasc Med Surg 2017; 5: 308.Google Scholar
16. Francis, CW, Kaplan, KL. Haemorrhagic problem in the surgical patient. Bleeding and thrombosis. In Holffman R, Benz BJ, Shattil SJ, Furis B, Cohen HJ, Stilberstein LE, MacGlare P (eds). Haematology Basic Principles and Practice. Churchill Livingstone, London, 2000: 2381–2391.Google Scholar
17. Blood Transfusion Task Force. Transfusion for massive blood loss. Clin Lab Haematol 1998; 10: 265–273.Google Scholar
18. Ranucci, M, Castelvecchio, S, Frigiola, A, Scolletta, S, Giomarelli, P, Biagioli, B. Predicting transfusions in cardiac surgery: the easier, the better: the transfusion risk and clinical knowledge score. Vox Sang 2009; 96: 324–332. Google Scholar
19. Van Straten, AH, Kats, S, Bekker, MW, et al. Risk factors for red blood cell transfusion after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2010; 24: 413–417.Google Scholar
20. Paone, G, Brewer, R, Theurer, PF, Bell, GF, Cogan, CM, Prager, RL. Michigan Society of Thoracic and Cardiovascular Surgeons. Preoperative predicted risk does not fully explain the association between red blood cell transfusion and mortality in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012; 143: 178–185.Google Scholar
21. Brucner, BA, Blan, LN, Rodriguez, L, et al. Microporous polysaccharide hemosphere absorbable hemostst use in cardiothoracic surgical procedures. J Cardiothorac Surg 2014; 9: 13.Google Scholar
22. Christensen, M, Krapf, S, Kempel, A, Avon, HC. Costs of excessive postoperative haemorrhage in cardiac surgery. J Thorac Cardiovasc Surg 2009; 138: 687–693.Google Scholar
23. Levy, JH, Depotis, GJ. Transfusion and haemostasis in cardiac surgery. Transfusion 2008; 48: 15.Google Scholar
24. Lapar, D, Crosby, I, Ailewadi, G, et al. Blood conservation is associated with improved outcome and reduced cost after cardiac surgery. J Thorac Cardiovasc Surg 2013; 145: 1796–1803.Google Scholar
25. Lopes, CT, Santos, TR, Brunori, EH, Moorhead, SA, Lopes, JL, Barros, AL. Excessive bleeding predictors after cardiac surgery in adults: integrative review. J Clin Nurs 2015, https://doi.org/10.1111/jocn.12936. [Epub ahead of print].Google Scholar
26. Nwafor, IA, Nwafor, MN, Eze, JC, Ezemba, N, Ngene, CI. Open heart surgery: management of nonsurgical bleeding in the perioperative period. Int J Vasc Surg Med 2017; 3: 008–012.Google Scholar
27. Irio, A, Paccetti, P, Makris, M. Perspective – clotting factor concentrate switching and inhibitor development in haemophilia A. Blood 2012; 120: 1–9.Google Scholar
28. Osaro, E, Charlse, AT. The challenges of meeting the blood transfusion requirements in sub-Saharan Africa: the need for the development of alternative to allogeneic blood. J Blood Med 2011; 2: 7–21.Google Scholar
29. Isaah, HA, Mamman, AI, Bababdoko, AA, Ahmed, AJ. Seroprevalence of hepatitis C antibodies among blood donors in Ahmadu Bello University Teaching Hodpital (ABUTH), Kaduna. Afr J Clin Exp Microbiol 2010; 11: 75–78.Google Scholar
30. Muktar, HM, Jones, M, Ashime, J. Hepatitis virus infection in blood donors: an emerging risk to transfusion services. Ann Afr Med 2006; 5: 182–184.Google Scholar