The use of blood and blood products in the maternity ward of Boitumelo Regional Hospital
Date
2013-01-23
Authors
Modiko, Serahome Obed
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
BACKGROUND: Recently, South African health system has been experiencing
shortage of blood and blood products due to increase in demand for conditions
(such as road accident injuries, assaults, surgery and complications of labour)
and decrease in supply due to conditions such as Human Immunodeficiency
Virus and Hepatitis B. This resulted in difficulty in managing conditions such as
obstetric haemorrhages which is one of the commonest causes of maternal
mortality and morbidity in South Africa. It was therefore important to monitor the
use of these products in South African hospitals to avoid inappropriate use as
well as to contain expenditure. However, no formal study has been done in
recent past to systematically study the use of blood and blood products in the
maternity units in these hospitals. The researcher believed that this study that
was conducted in the Boitumelo Regional Hospital based in the Free State would
provide evidence to provincial as well as institutional managers regarding the use
of blood and blood products and to quantify financial resources spent on these
items. This particular Hospital was chosen because of its significant expenditure
on the blood and blood products mainly for maternity patients.
AIM: To determine the extent of the use of blood and blood products in the
Maternity ward of the Boitumelo Regional Hospital and the factors that influenced
their uses.
METHODOLOGY: The study design was a cross-sectional study based on
retrospective review of routinely collected hospital data from hospital records of
patients for the period of 1 April 2009 to 31 March 2010. The setting of the study
was the maternity ward of Boitumelo Regional Hospital. Data was collected on
the following variables: types of blood and blood products transfused, profile of
patients transfused with blood and blood products, turn-around time and cost of
these products. Data from the hospital records was captured in the data
collection tools designed for the study and descriptive statistics was used to
report the findings. RESULT: This is probably the first study done at a regional hospital setting in
South Africa which looked at broad issues pertaining to the use of blood and
blood products in the Maternity ward of the Boitumelo Regional Hospital, and the
factors associated with these specified blood and blood products during one
study period. The study found 99 (4.2%) among these 2304 patients delivered
during this one year period received blood and blood products transfusion (13
units of whole blood, 250 units of red blood cells, 33 units of fresh frozen plasma
and 1 unit of platelet). Primiparity (32, 32.6%), pre-term labour (49, 49.5%),
booking status (unbooked 20, 20.4%) were found to be common among these
patients. A significant number of them (36, 36.4%) were anaemic based on their
booking haemoglobin but only a few of them were diagnosed and treated for
anaemia. Among the other antenatal diseases, Pregnancy Induced Hypertension
was commonest (27.3%) followed by Human Immunodeficiency Virus (15.2%).
The majority of the subjects who received transfusion had Normal Vaginal
Delivery signifying the need for active management of third stage. Only 5%
(36/776) of Caesarean Section patients received transfusion, which is much
lower than other studies. The median blood loss during delivery was 400 ml.
Seventeen (17.5%) patients were transfused before delivery and one (1%) was
transfused during delivery and 81 patients (81.5%) were transfused after
delivery. Eighteen of them (18.4%) were transfused for Antepartum
Haemorrhage and 81 (81.6%) of them were transfused for Postpartum
Haemorrhage. The median time interval between prescription and administration
was 160 min which is quite long and could be improved by reducing the interval
between prescription and ordering blood and interval between receipt and
administration. The total cost of transfusion during one year study period was R
329,579.27 (Whole blood: R7, 433.37, Red Blood Cell: R282, 192.50, Fresh
Frozen Plasma: R33, 411.37 and Platelet: R6, 542.03) and the average cost of
transfusion per patient was R3329.01.
CONCLUSION: The findings of this study will be reported to the Hospital
management for improving management of obstetrics patients. The researcher
also proposed further study among all the patients who received transfusion at all the regional hospitals in the Free State Province to compare the use of blood and
blood products in these institutions.