3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
3 results
Search Results
Item A retrospective audit of the use of fresh frozen plasma at a tertiary care hospital(2019) Gounden, ReenelleBackground: Blood transfusions reduce morbidity and mortality in hospitalized patients. Fresh Frozen Plasma (FFP) is one of the most commonly used blood products in many clinical settings as well as the one least understood in its indications for use. While guidelines on the use of FFP have been published by the South African National Blood Service (SANBS), there is a paucity of data on how well these are followed. Objectives: This study assessed the indications and appropriate use of FFPs in a tertiary care hospital. Method: A retrospective audit was conducted over six months from March to August 2015 at the CMJAH. The study was reviewed and approved by the University of the Witwatersrand and SANBS Human Research Ethics Committees. Study participants included all recipients of FFP at the CMJAH during the study period. Data on indications for FFP, volumes of FFPs transfused, clinical units transfusing the FFPs, were collected and analysed. Results: There was a total of 1233 FFP transfusions to 736 patients during this study period. 53.8% of these transfusions were appropriate following the SANBS blood transfusion guidelines while 39.4% were inappropriately transfused and a further 6.8% of FFP transfusions were indeterminate. The appropriate indications for FFP transfusions included multiple factor deficiencies, reversal of warfarin and thrombotic thrombocytopenic purpura. The inappropriate indications involved; bleeding without a coagulopathy, abnormal coagulation studies in a non-bleeding patient and prophylactic use before invasive procedures. Conclusion: In this retrospective audit, half FFP transfusions were appropriate while 40% were inappropriate according to current guidelines. This study highlights the need for education on the use of FFP in our institution.Item A study of coagulation disturbances in infectious disease with particular reference to the role of coagulation disturbances in salmonella typi infections(1986) Spencer, David, ColinApproximately 4,000 cases of typhoid fever are notified annually in South Africa. While localised gastrointestinal bleeding is common, a generalised haemorrhagic state remains unusual. Nevertheless recent reports have drawn attention to the high incidence of sub- clinical, laboratory diagnosed, intravascular coagulopathy. This study evaluates the incidence of coagulation disturbances in Black patients with typhoid fever. in addition to the contribution of disseminated intravascular coagulation (D. I. C.), the role of disturbed liver function in impaired haemostasis is assessed.Item Coagulation profiles of HIV positive and negative paediatric patients undergoing dental extractions at Charlotte Maxeke Johannesburg Hospital.(2013-04-24) Zeijlstra, Anne ElisabethPaediatric Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) remain a significant health care challenge in South Africa. Oral health and coagulation are only two of the many problems experienced by HIV positive paediatric patients. This research report began with an observation that known HIV positive paediatric patients bled more than known HIV negative paediatric patients or those with unknown HIV status while undergoing dental extractions at Charlotte Maxeke Johannesburg Academic Hospital. The observation prompted a prospective, contextual, descriptive study looking at the coagulation profile (platelet count and thromboelastogram (TEG) profile (reaction time (r-time), clot formation time (Ktime), alpha angle (α-angle) and maximum amplitude (MA)), CD4 counts and percentages and observed clinical bleeding in HIV negative, HIV positive not on antiretroviral treatment (ARVs) and HIV positive on ARVs paediatric patients presenting for dental extraction. Over a two year period 47 HIV negative, 12 HIV positive not on ARVs and 17 HIV positive on ARVs paediatric patients were enrolled in the study using a consecutive, convenience sampling method. Each paediatric patient was given a standard inhalational general anaesthetic using sevoflurane and during intravenous cannulation the researcher drew blood from each child for analysis. A senior dentist from the Department of Paediatric Dentistry assessed bleeding in all cases. The data obtained for each of the three study groups was compared using a oneway analysis of variance followed by pair wise comparison using the Bonferroni adjustment to address multiplicity. To deal with the big standard deviations and skewed data a one-way analysis of variance for ranks tested for differences between the groups. No statistically significant differences were found when comparing the groups for platelet count (p = 0.2087), TEG r-time (p = 0.4738), TEG K-time (p = 0.6967), TEG α-angle (p = 0.7948) or TEG MA (p = 0.2982). There was a statistically significant difference between the HIV negative and HIV positive not on ARVs groups (p = 0.000 and 0.004) and HIV positive on ARVs and HIV positive not on ARVs groups (p = 0.000 and 0.001) when comparing CD4 count and percentage. Patient groups were compared with respect to bleeding complications using the Fisher’s exact test. There was no statistically significant difference in observed bleeding between the three groups of paediatric patients. The entire HIV positive group was then compared for bleeding, and using the Welch t-test, adjusting for unequal variances it was found that there was statistically, significantly more bleeding in the HIV positive children with lower CD4 counts regardless of treatment with ARVs (p = 0.0129). These results were also confirmed using the Wilcoxon rank-sum test (p = 0.0335). Although this study showed statistically significant bleeding in HIV positive paediatric patients with lower CD4 counts, the tests of coagulation used in the study were unable to define the underlying pathogenesis. Further research into coagulation in HIV positive paediatric patients is needed.