Rational use of blood transfusion during open reduction and internal fixation in patients with isolated closed femoral fractures at Mulago Hospital

Background: Blood transfusion can be a life saving intervention. However, if blood is given when it is not needed, the patient receives no benefit and is exposed to unnecessary risk. Therefore, transfusion should be prescribed only when the benefits to the patient are likely to outweigh the risks. Objective: To evaluate the rationale for blood transfusion in patients undergoing open reduction and internal fixation (ORIF) for isolated closed femoral fractures during the study period in Mulago Hospital. Design: This was a cross-sectional analytical study. Setting: Orthopaedic theatre, Mulago National Hospital, Uganda. Methods: Purposive sampling was used.These were patients in Ward 7 of Mulago Hospital. The allowable blood loss was calculated using the haemodilution method. Blood loss was calculated by weighing dry and blood soaked gauze swabs. The amount of intravenous fluids was recorded. The patient was monitored for pulse rate, blood pressure and urine output. Data processing and analysis was done by use of SPSS-10 package. Results: Only 55% of patients required blood by WHO criteria intraoperatively. Of those who actually received blood 35.5% were irrational. Conclusion: Physiological monitoring is an effective way of determining which patients require blood transfusion as per the WHO criteria during ORIF of isolated closed femoral fractures. Only 55% of the blood transfusions were rational as per the WHO criteria during the study period. East African Orthopaedic Journal, Vol. 4: September 2010