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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: [email protected]
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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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