The Blood Transfusion Outcomes and Analysis of Factors Associated with Blood Transfusion Reactions in Orthopaedic Trauma Patients Managed at Moi Teaching and Referral Hospital, Eldoret, Kenya
DOI:
https://doi.org/10.14738/bjhr.1301.19838Keywords:
Blood group, Blood transfusion, Manage, Orthopaedic trauma, Outcomes, ReactionAbstract
Background: Blood transfusion is required in the management of life threatening orthopaedic trauma hemorrhage. However, it is necessary to categorize the patients on the need for blood transfusion as well as adhering to the blood transfusion guidelines in order to avoid risks and hence ameliorate challenges and have good outcomes. Objective: To establish the blood transfusion outcomes and analyze the factors associated with blood transfusion reactions in the orthopaedic trauma patients managed at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: A hospital based descriptive cross-sectional study of 132 transfused orthopedic trauma patients was carried out between March, 2019 and January, 2020 at MTRH, after approval by relevant authorities. The patients were recruited by consecutive sampling method. Data on blood transfusion outcomes, as well as on factors associated with blood transfusion reactions (Sociodemographic, trauma and laboratory characteristics) was collected using interviewer administered structured questionnaire. Analysis of the aforementioned factors using the Fisher’s Exact Test was done and p value < 0.05 was considered statistically significant. Results: A total of 15 out of 132 patients (11.4%) had minor blood transfusion reactions. No mortality was recorded. Majority (6) were young (age group 21- 30 years old), followed by age group 41- 50 years old (5). Male (10) dominated over female (ratio- 2:1). Majority (13) were victims of RTA, 8 had long bones fractures, and debridement done in 8 patients. Majority (12) had Haemoglobin level of 7.1- 10.0 g%, and blood groups A+ and O+ (5 each). The findings on analysis of association of blood transfusion reactions and the stated factors were all not statistically significant (p>0.05). Conclusion: The incidence of blood transfusion reactions was low (11.4%). Majority of patients were young with male dominance. Majority of patients were victims of RTA, with long bones fractures who were done debridement. Most were of moderate low haemoglobin level and of blood groups A and O positive. Recommendations: High index of suspicion is necessary for diagnosis of blood transfusion reactions and cautions to eradicate these reactions be put in place. Further study on healthcare providers’ knowledge on blood transfusion, and the pattern of reactions noted in this study need be encouraged.
References
Abbas, K., Askari, R., Umer, M., & Hafeez, K. (2014). Transfusion practice in orthopedic patients : do we really need it ? S-145. Journal of Pakistan Medical Association, 64(12): 144–150.
Agaja Samuel Babatunde. (2009). Overview of Blood Transfusion in Orthopaedic Trauma in Ilorin, Nigeria. Nigerian Journal of Orthopaedics and Traum, 8(2): 69–71.
Ayumba, B. R., et al., (2024). Characterization of Orthopaedic Trauma Patients and the Need for Blood Transfusion at Moi Teaching and Referral Hospital, Eldoret, Kenya. Int J Adv Res Ortho., 6(1): 180028. Available at: https://academicstrive.com/IJARO/
Brunskill, S. J., Millette, S. L., Shokoohi, A., Pulford, E. C., Doree, C., Murphy, M. F., & Stanworth, S. (2015). Red blood cell transfusion for people undergoing hip fracture surgery. The Cochrane Database of Systematic Reviews, (4): CD009699.
Cherian, M. S. (2002). Clinical Use of Blood. Indian Journal of Anaesthesia, 46(2): 149–150.
Cochran, W. G., & Wiley, J. (1977). Sampling Techniques third edition (3rd ed.). New York: John Wiley & Sons, Ltd.
Dolenc, A. J., Morris, W. Z., Como, J. J., Wagner, K. G., & Vallier, H. A. (2016). Limited Blood Transfusions Are Safe in Orthopaedic Trauma Patients. Journal of Orthopaedic Trauma, 30(12): e384–e389.
Friedman, T., Javidroozi, M., Lobel, G., & Shander, A. (2017). Complications of Allogeneic Blood Product Administration, with Emphasis on Transfusion-Related Acute Lung Injury and Transfusion-Associated Circulatory Overload. Advances in Anesthesia, 35(1): 159–173.
Greg McLatchie, Neil Borley & Joanna Chikwe, (2007). Transfusion reactions, In: Oxford Handbook of Clinical Surgery, Third Edition. Oxford University Press. Great Clarendon Street, Oxford OX2 6DP, United Kingdom.
Hart, A., Khalil, J. A., Carli, A., Huk, O., Zukor, D., & Antoniou, J. (2014). Blood Transfusion in Primary Total Hip and Knee Arthroplasty. Incidence, Risk Factors, and Thirty-Day Complication Rates. JBJS, 96(23): 1945–1951.
Hoffman, R., Benz, E., Silberstein, L., Heslop, H., Weitz, J., Anastasi, J., Salama, M., & Abutalib, S. (2018). Hematology - Basic Principles and Practice (8th ed.). Philadelphia: Elsevier.
Johnston, P., Wynn-Jones, H., Chakravarty, D., Boyle, A., & Parker, M. J. (2006). Is Perioperative Blood Transfusion a Risk Factor for Mortality or Infection After Hip Fracture? Journal of Orthopaedic Trauma, 20(10): 675–679.
Kenya National Blood Transfusion Service. (2009). Guidelines for the Appropriate Use of Blood and Blood Products (3rd ed.). Nairobi: Ministry of Health.
Kibiwot, N. G., Ayumba, B. R., & Cherop, L. T. (2025). Appropriate Blood Usage and Adherence to Guidelines in Orthopaedic Patients Managed at Moi Teaching and Referral Hospital, Eldoret, Kenya. British Journal of Healthcare and Medical Research, Vol - 12(1). 49- 65.
MTRH. (2016). Guidelines on Safe and Appropriate Use of Blood and Blood Components. Eldoret.
MTRH website, (n.d.). Available at: https://www.mtrh.go.ke
Malone, D. L., Dunne, J., Tracy, J. K., Putnam, A. T., Scalea, T. M., & Napolitano, L. M. (2003). Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. The Journal of Trauma, 54(5): 897–898. Scholar Publishing
Mullis, B., Fisk, E., Weaver, D., Zhao, Q., Daggy, J., & Di Cesare, P. E. (2015). Anemia versus transfusion: does blood conservation increase the risk of complications? American Journal of Orthopedics (Belle Mead, N.J.), 44(1): E11-16.
Muriithi, M. P. (2013). Blood Transfusion in Elective Orthopaedic Surgeries at The Kenyatta National Hospital. MMed Thesis, University of Nairobi.
Murphy, M., Roberts, D., & Yazer, M. (Ed.). (2017). Practical Transfusion Medicine (5th ed.). Hoboken, New Jersey: WILEY Blackwell.
Newman, C., Tran, P., McGregor, S., & Bramley, D. (2018). Patient blood management strategies in total hip and knee arthroplasty. Current Orthopaedic Practice, 29(1): 31–36.
Ngetich, G. K. (2021). Blood transfusion practices in orthopaedic trauma units at Moi Teaching and Referral Hospital, Eldoret, Kenya. Master of Medicine (Orthopaedic Surgery) of Moi University, Eldoret, Kenya.
Ngetich, G. K., Ayumba, B. R. & Lotodo, T. C. (2024). Characterization of Orthopaedic Trauma Patients and the Need for Blood Transfusion at Moi Teaching and Referral Hospital, Eldoret, Kenya. Int J Adv Res Ortho., 6(1): 180028. Available at: https://academicstrive.com/IJARO/
Parker, M. J. (2013). Randomised trial of blood transfusion versus a restrictive transfusion policy after hip fracture surgery. Injury, 44(12): 1916–1918.
Paydar, S., Chaabi, M., Akhavan, M., Ghahramani, Z., & Dehghankhalili, M. (2017). Outcome Determinants of Patients with Traumatic Pelvic Fractures: A Cohort Study in a Level I Trauma Center in Southern Iran. Malaysian Orthopaedic Journal, 11(3): 23–30.
R Core Team. (2019). R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing.
Ristagno, G., Beluffi, S., Tanzi, D., Belloli, F., Carmagnini, P., Croci, M., … Savoia, G. (2018). Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery. Journal of Clinical Medicine, 7(2): E19.
Saidi, H. (2016). Major Injury Cases in Nairobi: Characterization of Contexts , Outcomes and Injury Documentation. PhD Thesis, University of Nairobi.
Salverda, M., Ketharanathan, N., Van Dijk, M., Beltchev, E., Buys, H., Numanoglu, A., & Van As, A. B. (2017). A review of blood transfusions in a trauma unit for young children. South African Medical Journal, 107(3): 227-231.
Sambandam, B., Batra, S., Gupta, R., & Agrawal, N. (2013). Blood conservation strategies in orthopedic surgeries: A review. Journal of Clinical Orthopaedics and Trauma, 4(4): 164–170.
Teng, Z., Zhu, Y., Liu, Y., Wei, G., Wang, S., Du, S., & Zhang, X. (2015). Restrictive blood transfusion strategies and associated infection in orthopedic patients: a meta-analysis of 8 randomized controlled trials. Scientific Reports, 5: 13421.
World Health Organisation. (2002). The Clinical Use of Blood - Handbook. Geneva: WHO.
Young, S. W., Marsh, D. J., Akhavani, M. A., Walker, C. G., & Skinner, J. A. (2008). Attitudes to blood transfusion post arthroplasty surgery in the United Kingdom: A national survey. International Orthopaedics, 32(3): 325–329.
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