Safety and effectiveness of systematic liquid predeposit autologous blood transfusion for major elective orthopaedic surgery at Mulago Hospital, Uganda

Abstract

Liquid predeposit autologous blood transfusion in major orthopaedic surgery had gained prominence over the years as indisputably the safest and best matched blood available as it eliminates all the risks associated with homologous blood transfusion most notably HIV infection. Inspite of the knowledge about the safety of liquid predeposit autologous blood transfusion, no study had ever been carried out to evaluate the safety and effectiveness of this form of blood transfusion at mulago hospital. A prospective study on the safety and effectiveness of liquid predeposit autologous blood transfusion was carried ut on 66 patients between the ages of eight and seventy five years electively selected for major orthopaedic surgery at the area of study and satisfying the study criteria. All the 66 patients were stratified according to age, sex, religion, procedure. Predeposit haemoglobin and haemotocrit. MSBOS, number of autologous units donated, preoperative haemoglobin and haematocrit. Blood pressure and pulse rate. The patients were started on ferrous sulphate tablets one week prior to predepositing blood and continued until the night before the day for surgery. Those whose MSBOS was more than two units pre-donated at seven days interval with the last donation occurring not less than seventy two hours before surgery. Blood collected and stored into CPDA-1 was stored in the blood bank at a temperature of 4 + -2C after proper labeling with the patients signature for pretransfusion checking. The blood donated was purely for auto-transfusion and was therefore not subjected to any screening. However, the patients blood group was determined and homologous blood cross- matched for homologous transfusion in case need arose. Some packs of blood not transfused amounting to 6.7% of total blood collected and stored was cultured for both aerobics and anerobes as a quality control measure. Two research assistants who were laboratory technicians were recruited to assist with investigations and predonations ans ensure safe and proper storage of the blood. Apre tested evaluation form was used to collect data. Data processing and analysis was done by use of SPSS-PC package and relevant statistics generated. Results were presented in form of tables and figures. All the 66 patients who participated in the study successfully completed their prescribed predonation schedules and had their autologous blood available during surgery. Only 7 patients (10.6%) had mild donors reactions (mild dizziness). Out of the 145 units of blood autodonated only 71 units were autotransfused. Half of the patients never required blood, But the other 50% who required blood only received their own blood none of them requiring homologous blood. None of those who received their autodonated blood experienced transfusion reactions. Children as young as 8 years and adults as old as 75 years were able to tolerate weekly autodonation procedures. The mild donor reactions that occurred in 10.6% of the patients were not statistically significant (p>0.05). The study has demonstrated that the technique is safe and effective in blood provision for major elective orthopaedics surgery for both children as young as 8 years and adults as old as 75 years completely eliminating the risks of homologous blood transfusion. This facility should therefore not be underutilized.