3. Electronic Theses and Dissertations (ETDs) - All submissions
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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 Audit of blood product transfusion in paediatric congenital heart surgery on cardiopulmonary bypass(2018) Bayebaye, Caroline TumeloBackground Cardiac surgery is associated with perioperative bleeding which may result in the need for blood transfusion, particularly in paediatric congenital cardiac surgery performed on cardiopulmonary bypass (CPB). Regular auditing of practices is imperative for improvements to be realised. Methods Retrospective, contextual, descriptive data of 105 patients were collected for the period January to December 2014. Results The median age of patients was 4 (1–6) years, weight 13 (8.4–20) kg, with mean lowest CPB haemoglobin of 8.3 (1.5) g/dL. There was a statistically significant difference in median red packed cells (RPC), platelet and cryoprecipitate units transfused per patient across Risk Adjusted classification for Congenital Heart Surgery categories (p=0.03, p=0.0013, p=0.0001). There was a statistically significant correlation between transfused fresh frozen plasma units with CPB time (r=0.2634, p=0.0199) and RPC units transfused (r=-0.4654, p<0.001). Conclusion Although no standardised transfusion guidelines were available, overall blood product transfusion was comparable to previous reports.Item Assessment of the knowledge of usage of blood and blood products amongst medical doctors in the Department of Medicine at the Faculty of Health Sciences, University of the Witwatersrand affiliated academic hospitals(2017) Laher, MuhammadBackground Rational and appropriate use of blood and blood products is important in a resource limited setting. Proper education is required in decision-making and management with regard to blood transfusion. Current knowledge status is required in order to identify target areas of teaching. Objective To assess the knowledge regarding blood and blood products among doctors of varying ranks at the University of the Witwatersrand affiliated academic hospitals. Research design and methods This is an observational, descriptive study using a self-administered questionnaire. The questionnaire was divided into sections covering areas of red blood cells, platelets, plasma products, consent, blood ordering and side effects with a total of 40 questions, approximately equally distributed in each of the above sections. A section on the demographics of the participants as well as an opinion section of how to impart further information was also included comprising of 2 questions each. Results A response rate of 33% was obtained from the distributed questionnaires. The average score obtained for the questionnaire was 61% amongst all the doctors. The consultants achieved the highest score of 64%. In comparison, the interns, who averaged 56%, achieved the lowest score. The medical officers and registrars both averaged 63%. The community service doctors averaged 58%. A similar gradient was seen across the different sections of the questionnaire. Participants scored the best in the section pertaining to ‘consent’ with a score of 87%. The next best score (64%) was achieved for the section regarding ‘side effects’. The section regarding ‘red blood cell usage’ and ‘blood product ordering’ was scored at 60%. The section with regards to ‘platelets usage’ achieved a score of 44%. The lowest score was achieved in the section regarding ‘plasma product usage’, i.e. 30%. A statistically significant gap in knowledge was noted from intern up to medical officer level, after which the increase in knowledge up to consultant level was not found to be statistically significant. Conclusions The overall results obtained appear to be suboptimal and can be improved upon significantly. Formalized and on-going teaching around blood and blood product usage is required at the University of the Witwatersrand affiliated hospitals, at all levels, from interns through to consultants to ensure that this scarce, but invaluable resource is used judiciously and appropriately.