PATTERN OF ORDERING AND USAGE OF HOMOLOGOUS BLOOD TRANSFUSION FOR MAJOR ELECTIVE MAXILLOFACIAL SURGERY AT THE LAGOS UNIVERSITY TEACHING HOSPITAL

Abstract

Justification for the requests for homologous blood that accompany major elective maxillofacial surgical procedures is difficult to establish in most cases. This attitude of ordering for cross-matched blood is understandable in today's legal climate, but has led to serious problems in terms of laboratory inefficiency which can no longer be ignored. To evaluate the pattern of ordering and use of homologous blood, and transfusion ratios for major elective maxillofacial surgeries at the Lagos University Teaching Hospital (LUTH), Idi-Araba Lagos. Sixty-three consecutive subjects who required major elective maxillofacial surgery under general anaesthesia, and who met the inclusion criteria were included in the study. Data collected included age, sex, weight, and height of subjects, type of surgery done, preoperative and intraoperative haemoglobin concentration, blood units cross-matched and units transfused intraoperatively. Each subject was made to donate through a representative donor, at least one unit of homologous blood prior to surgery.   There was a male predominance (57.1%) among subjects, with male to female ratio of 1.3 : 1. Mean age of subjects was 33.9 13.5 years. O+ was the most predominant blood group (62%). Tumours (58.8%), were the most common indication for surgery. Majority of subjects (95.2%), had a preoperative haemoglobin concentration of ? 10 g/dl.  Haemoglobin concentration at the point of transfusion was ? 10 g/dl for 58.8% of transfused subjects. The overall cross-match to transfusion ratio was 3.35, overall probability of transfusion was 26.9%, while the overall transfusion index was 0.6. Only oncological surgical procedures showed an efficient blood usage in all the 3 indices.   This study also demonstrated that only onclogical surgical procedures have an indication for cross-matching of blood for surgery, however there is a need to determine the maximum surgical blood ordering schedule for these procedures. There is therefore the need to change the blood ordering pattern, and minimize over-ordering of blood for major elective maxillofacial surgery.medicine