A Review of Massive Blood Transfusion and its Associated Syndromes in Zimbabwe

Background and objectives: Massive blood transfusion is defined as transfusion approximating or exceeding a patient's total blood volume (5-6 litres in adults) within 24-hours. This procedure is used to manage severely anaemic and bleeding patients. Negative outcomes associatedwith acidosis, hypothermia and coagulopathy may result. The study was carried out to review the management of massive transfusion in Zimbabwe.Materials and methods: A 4-year retrospective clinical laboratory-based study was carried out on patients who had massive blood transfusionat a Zimbabwean hospital, from January 2014 to December 2017. Data was collected from patients’ hospital records after permission from thehospital director.Results: Of the 180 patient records, 145 (80.6%) were from female and 35 (19.4%) from male patients. Massive blood transfusion was done mostly on obstetric patients. Full blood count was the most commonly requested laboratory test, with 155 (86%) requests. Some of the patients had severe anaemia. Routine coagulation tests were significantly abnormal. All patients received packed red cells during the first 24 hours, followed by fresh frozen plasma (57.8%). Platelets, cryoprecipitate and whole blood were infrequently transfused (22%, 3% and 2% respectively). The mortality rate was 25.6% within 24 hours after transfusion. Transfusion of packed red cells alone was significantly associated with mortality (p<0.001) which increased significantly with the use of high numbers of packed red cell units.Conclusion: Massive blood transfusion is associated with a high mortality rate in Zimbabwe. Transfusion of packed red blood cells alone resulted in highest mortality. There was an insufficient use of laboratory tests to monitor massive blood transfusion. This potentially can be addressed by establishing a national massive transfusion protocol for Zimbabwe. French Title: Une revue de la transfusion sanguine massive et de ses syndromes associés au Zimbabwe Contexte et objectifs: La transfusion sanguine massive est définie comme une transfusion se rapprochant ou dépassant le volume sanguin total d'un patient (5-6 litres chez l'adulte) dans les 24 heures. Cette procédure est utilisée pour gérer les patients gravement anémiques et hémorragiques. Des résultats négatifs associés à l'acidose, l'hypothermie et la coagulopathie peuvent en résulter. L'étude a été réalisée pourexaminer la gestion de la transfusion massive au Zimbabwe.Matériel et méthodes: Une étude rétrospective clinique en laboratoire de 4 ans a été menée sur des patients ayant subi une transfusion sanguine massive dans un hôpital du Zimbabwe, de Janvier 2014 à Décembre 2017. Les données ont été collectées à partir des dossiers des patients de l'hôpital après autorisation du Directeur de l'hôpital.Résultats: Sur les 180 dossiers de patients, 145 (80,6%) provenaient de femmes et 35 (19,4%) de patients de sexe masculin. Une transfusion sanguine massive a été effectuée principalement sur des patientes obstétricales. L'hémogramme complet était le test de laboratoire le plus demandé, avec 155 (86%) demandes. Certains patients souffraient d'anémie sévère. Les tests de coagulation de routine étaient significativement anormaux. Tous les patients ont reçu des concentrés de globules rouges au cours des 24 premières heures, suivis de plasma frais congelé (57,8%). Les plaquettes, le cryoprécipité et le sang total ont été rarement transfusés (22%, 3% et 2% respectivement). Le taux de mortalité était de 25,6% dans les 24 heures suivant la transfusion. La transfusion de concentrés de globules rouges seule était significativement associée à la mortalité (p<0,001) qui augmentait significativement avec l'utilisation d'un nombre élevé d'unités.Conclusion: La transfusion sanguine massive est associée à un taux de mortalité élevé au Zimbabwe. La transfusion de concentrés de globules rouges seule a entraîné la mortalité la plus élevée. Les tests de laboratoire étaient insuffisants pour surveiller les transfusions sanguines massives. Cela peut potentiellement être résolu en établissant un protocole national de transfusion massive pour le Zimbabwe

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Purpose we aimed to describe traumatic pelvic fracture in multinational level 1 trauma centers. Methods We conducted a retrospective analysis for all patients with traumatic pelvic fracture (TPF) between 2010 and 2016 at 2 trauma centers in Qatar and Germany. Results A total of 2112 patients presented with traumatic pelvic injuries of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41.2±21.1 years. Falls, motor vehicle crashes and pedestrians were the most frequent mechanisms involved. Chest (37.3%) was the most commonly associated injured region, with mean injury severity score (ISS) of 16.5±13.3. Hemodynamic instability was observed in 44%, blood was needed in a third, massive transfusion in a tenth and intensive care admission in a quarter of cases. Tile classification was possible in 1228 patients (type A in 60%, B in 30% and C in 10%). Patients with type C had higher rates of associated injuries, ISS, pelvis abbreviated injury score (AIS), more need for blood transfusion, massive transfusion protocol activation, prolonged hospital stay, higher rate for surgery, complications, and mortality (p<0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stay were 15 and 5 days, respectively. In-hospital complications were few and the overall mortality rate was 4.7% (86 patients). Conclusion pelvic fracture is a common injury. It needs a careful multidisciplinary and systematic approach to address the associated complexities and polytrauma nature in order to improve the associated outcomes both on a short and long-term basis.