J. R. Gallaher1, G. Mulima2, C. G. Shores1, A. G. Charles1,2 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA 2Kamuzu Central Hospital,Surgery,Lilongwe, , Malawi
Introduction:
Surgical bleeding can result in substantial morbidity and mortality in the absence of blood transfusion services. Unfortunately, these services remains largely unavailable, unreliable, and unsafe in low-resource countries, especially sub-Saharan Africa. The World Health Organization has addressed these shortages with a policy emphasizing blood safety using centralization and donor restriction. This study sought to characterize the availability of blood products over time for patients with acute hemorrhage at a tertiary center in sub-Saharan Africa, using upper gastrointestinal (UGI) bleeding as a proxy.
Methods:
This is a prospective observational study of adults presenting to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi with clinical signs of acute UGI bleeding over two years (2011-2013). KCH is a resource-poor public, tertiary hospital. We used linear regression modeling to analyze the change in blood product utilization per patient over time, adjusted for presenting hemoglobin.
Results:
293 adult patients with UGI were enrolled with a mean age of 41.8 years (SD 15.8) and a male preponderance (61.4%). The mean presenting hemoglobin level was 7.2 (SD 3.4) g/dL with 56.1% of patients having a hemoglobin <7 g/dL. A majority (71.3%) of patients received at least one unit of whole blood and the mean number of blood units received was 2.3 (SD 1.4). Only 50.2% of patients received their first transfusion on the day of admission. There was a linear relationship between presenting hemoglobin and the number of units of blood transfused as patients with a lower hemoglobin level received more blood. Over the two-year study period, the mean number of units transfused decreased linearly from 2.5 units (95% CI 2.1, 2.9) at the beginning of the study to 1.3 units (95% CI 0.9, 1.7) at the end, when adjusted for presenting hemoglobin (p=0.0014).
Conclusion:
At a tertiary center in sub-Saharan Africa, the availability of blood products for acute hemorrhage appears to have decreased over time in the context of substantial policy changes over the last decade. We cannot make substantial progress on the reduction of surgical morbidity and mortality in the absence of a rational blood banking policy that balances both safety and supply.
