Subescalas CES Profesores
PROFESORES DEL CENTRO EDUCATIVO RURAL Grafico N
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Table 1. Age distribution of the 216 patients that had elective surgery.
Age (Yrs)
Male (M-t) Female (F-t) Total (%)
<20 7 (2) 3 (0) 10 (4.6) 20-24 8 (2) 6 (1) 14 (6.5) 25-29 15 (7) 7 (2) 22 (10.2) 30-34 14 (5) 6 (2) 20 (9.3) 35-39 9 (4) 7 (4) 16 (7.4) 40-44 10 (6) 8 (5) 18 (8.3) 45-49 14 (6) 7 (3) 21(9.7) 50+ 60 (31) 35 (20) 95(44.0) Total 137 (63) 79 (37) 216 (100.0)
NB: M-t; number of male patients that had transfusion F-t; number of female patients that had transfusion
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Table 2. Ethnic group distribution of the 216 patients that had elective surgery.
Tribe Male Female Total (%) Hausa/
Fulani
74 42 116 (53.7)
Igbo 6 4 10 (4.6)
Yoruba 13 11 24 (11.1) Others 40 26 66 (30.6) Total 133 83 216 (100.00)
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Table 3. Occupation of the patients.
Occupation Male Female Total %
H/W - 44 44 20.4
Teacher 3 11 14 6.5 Farmer 29 0 29 13.4 Trader 25 8 33 15.3 Student 23 8 31 14.4 Retiree 18 5 23 10.7
C/S 21 5 26 12.0
Driver 5 0 5 2.3 Others 4 7 11 5.1 Total 128 88 216 100 NB: H/W; Housewives, C/S; Civil servants,
%; Percentage.
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Based on region, 22(10.1%) cases of head and neck disorders were seen, thoracic surgeries made up 38(17.6%), abdomen 81(37.5%), genitourinary 36(16.7%) and others 39(18%). Based on pathology, malignant tumors made up 105(48.6%), benign tumors 34(15.7%) while others were 77(35.7%). Based on specialty, general surgeries made up 132(61.1%), urology 52(24.1%), ear/nose/throat 12(5.6%) and others 20(9.3%) (Table 4 and Figure 1).
Patient distribution.
Table 4.
Diagnosis (region) by sex in 216 patients that had elective surgery.
Diagnosis Male Female Total % Head & Neck 10 12 22 10.2 Thoracic 5 33 38 17.6 Abdomen 51 30 81 37.5 Genitourinary 32 4 36 16.7 Others 22 17 39 18.0 Total 120 96 216 100.00
NB; Others include squamous cell carcinomas, neurofibromas, soft tissue sarcomas etc.
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Figure 1.
The distribution of Clinical disorders based on region in relation to sex.
(In Percentage)
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Table 5.Diagnosis (pathology) by sex in 216 patients that had elective surgery.
Diagnosis Male Female Total % Benign tumors 21 13 34 15.7 Malignant tumors 61 44 105 48.6
Others 35 42 77 35.7
Total 117 99 216 100.00
NB; Others include cholecystitis, haemorrhoids, hernias, hydrocele, urethral strictures.
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Table 6.Diagnosis (specialty) by sex in 216 patients undergoing elective surgery.
Diagnosis Male Female Total % General surgical 102 30 132 61.1 Urologic 47 5 52 24.1
ENT 8 4 12 5.6
Others 13 7 20 9.3
Total 170 46 216 100.00
NB; Others include squamous cell carcinomas, neurofibromas, basal cell carcinomas, fibromeningiomas.
General surgical disorders include gastrointestinal cases, breast diseases, thyroid disorders.
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Prevalence of anaemia.
Sixty one (28.24%) patients had anaemia using a critical packed cell volume of less than or equal to 30%. The causes of the anaemia were as follows;
gastrointestinal bleeding 31(14.4%), hook worm infestation 17(7.9%), genitourinary bleeding 12(5.6%) and sickle cell anaemia 1(0.5%) (Table 7).
Table 7. Causes of anaemia in the 61 patients who had elective surgery with a preoperative packed cell volume less than 30%.
Causes Male Female Total %
GIT bleeding 22 9 31 14.4
H/W infestation 12 5 17 7.9
GUT bleeding 9 3 12 5.6
SCA 1 0 1 0.5
TOTAL 44 17 61 28.4
NB:
H/W=Hookworm, GIT=Gastrointestinal tract,
GUT=Genitourinary tract,
SCA=Sickle cell anaemia
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Prevalence of the blood transfusion demand among the patients.
The overall average blood loss during surgical intervention was 252mls (range=10-1300mls). Based on region, head and neck surgeries had the lowest units of blood transfusion (9) with a transfusion index of 5.2% and an average blood loss of 129mls while abdominal surgeries had the highest number of units of blood
transfusion with a transfusion index of 54.3% and an average blood loss of 422mls.
Based on pathology, benign tumors had 25 units of blood transfusion with a
transfusion index of 29.4% and an average blood loss of 197mls, malignant tumors had 239 units of blood transfusion with a transfusion index of 66.7% and an
average blood loss of 359mls.
Based on specialty, ear/nose/throat (ENT) cases had 5 units of blood transfusion with a transfusion index of 33.3% and an average blood loss of 62mls, while general surgeries had 238 units of blood transfusion with a transfusion index of 53% and an average blood loss of 323mls (Table 8 and Figure 2).
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Table 8.
Clinical disorders in relation to average blood loss and transfusion index in the 216 patients that had elective surgery (Diagnosis by Region).
Diagnosis No. of No. transfused CM request Avg.vol.of Units of bld TI(%) (Region) cases Bld loss(mls) transfused
Head &
Neck 22 5 39 129 9 5.2
Thoracic 38 20 84 228 55 52.6
Abdomen 81 44 247 422 168 54.3 Genitourinary 36 21 93 155 47 58.3
Others 39 10 65 133 28 25.6
Total 216 100 528 - 307 NB;No. of cases=Number of cases
No. transfused = Number transfused CM Request = Crossmatch Request
Avg. vol. of bld loss = Average volume of blood loss TI = Transfusion Index
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Figure 2.
Clinical disorders based on region in relation to the average blood loss, units transfused and transfusion index.
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Table 9. Clinical disorders in relation to average blood loss and transfusion index in the 216 patients that had elective surgery (Diagnosis by Pathology)
Diagnosis No. of No. transfused CM request Avg.vol. of Units of bld TI cases bld loss(mls) transfused (%) Benign
Tumors 34 10 70 197 25 29.4 Malignant
Tumors 105 70 324 359 239 66.7 Others 77 20 134 174 43 26.0 Total 216 100 528 307
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Table 10. Clinical disorders in relation to average blood loss and transfusion index in the 216 patients that had elective surgery (Diagnosis by Specialty).
Diagnosis No. of No. CM Avg.vol. of units of bld TI (Specialty) cases transfused request bld. Loss(mls) transfused (%) General
Surgery 132 70 354 323 238 53.0 Urology 52 21 93 172 47 40.4 ENT 12 4 10 62 5 33.3 Others 20 5 71 90 2 25.0 Total 216 100 528 307
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Table 11. Diagnosis (Region) and the Cross:match Transfusion Ratio for the 216 patients that had elective surgery.
Diagnosis CM Req Units Trans CM:T Ratio
H&N 39 9 4.3
Thoracic 84 55 1.5
ABD 247 168 1.5
GUS 93 47 2.0
Others 65 28 2.3
Total 528 307 1.7
NB;CM Req = Crossmatch Request Units Trans = Units Transfused
CM:T Ratio = Crossmatch:Transfusion Ratio H&N=Head and Neck
GUS=Genitourinary system ABD=Abdomen
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Out of the total number of surgical cases seen in the study, 100 (46.3%) had blood transfusion. The overall cross match transfusion ratio was 1.7 (figure 3), that is out of the 528 cross match requests (average=2.5; range=0-8), 307 (58%) transfusions were carried out. There were 142 pre operative transfusions (average=0.6;
range=0-4), 75 intra operative transfusions (average=0.3; range=0-4) and 90 post operative transfusion (average=0.4; range=0-3). Allogeneic blood transfusion was the predominant type with 96 (96%) while only 4 (4%) cases of autologous blood transfusion were recorded.
Figure 3. Crossmatch:transfusion ratio of the clinical disorders based on region.
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Table 12. Diagnosis (Specialty) and the Crossmatch:Transfusion Ratio for the 216 patients that had elective surgery.
Diagnosis CM Req Units Trans CM:T Ratio
GS 354 238 1.5
Urology 93 47 2.0
ENT 10 5 2.0
Others 71 2 35.5
Total 528 307 1.7
NB:GS=General surgery
ENT=Ear, Nose and Throat
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Figure 4. Crossmatch:Transfusion Ratio of various clinical conditions based on specialty.
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Table 13. Diagnosis (Pathology) and the Crossmatch:Transfusion Ratio for the 216 patients that had elective surgery.
Diagnosis CM Req Units Trans CM:T Ratio
Benign Tumors 70 20 3.5
Malignant Tumors 324 239 1.4
Others 134 43 3.1
Total 528 307 1.7
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Figure 5. Crossmatch:transfusion ratio of clinical disorders based on pathology.
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During the study period, 4(1.9%) cases of autologous transfusion were seen and all had normovolaemic haemodilution. The cases were maxillary ameloblastoma (2), sinonasal carcinoma (1) and chronic rhinitis (1).
Out of the 307 transfusions, 295(96.1%) were commercial donors, 10 (3.3%) were replacement donors while only 2(0.6%) were voluntary non remunerated blood donors.
During the study period only 5 (5%) patients had transfusion reaction and all the transfusion reactions were acute febrile reactions due to immune reactions to donor white blood cells.
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Haematological Parameters:
The overall mean pre-operative packed cell volume was 33.7%±5 (range=20-45%), that of the 24 hours post-operation was 34.1%±3 (range=20-43) while that of 1 week post-operation was 35.5%±4 (range=25-44). The overall mean pre-operative white blood cell count was 6.5x109/l±1.5 (range=3-12.8x109/l) while that of the 1week post-operation was also 6.5x109/l±1.8 (range=3.5-11x109/l). The overall mean reticulocyte count pre-operatively was 1.9% ±0.5 (range=1-1.8%) while that of the 1 week post-operation was 1.7% ±0.4 (range=1-5.1%).
For head and neck surgeries the results showed the following; pre-operative mean packed cell volume (pcv 0) 28.5%±2.6, mean packed cell volume 24hours post operation (PCV 24hrs) 32.2%±3 and packed cell volume 1 week post-operation (pcv 1wk) 33.4%±3. In the case of abdominal surgeries the PCV 0 was 25.1%±2.8, PCV 24hours was 30.8%±3 and PCV 1wk was 35.1%±3.5. Benign tumors had the following mean packed cell volume values, PCV 0 as 23.1%±1.5, pcv 24hours as 32.3%±2 and PCV 1wk as 35.6%±3.5 while malignant tumors had pcv 0 as 29.2%±2.5, PCV 24hrs as 33.5%±3 and PCV 1wk as 34.2%±3. ENT surgeries had the following mean PCV values, PCV 0 as 30.2%±2, PCV 48hrs as 33.1%±2.5 and PCV 1wk as 34.2%±3 while general surgery cases had pcv 0 as 24.3%±1.6, PCV 24hrs as 30.8%±2.2 and PCV 1wk 32.6 %±2.5 (Tables 14, 15 and 16).
The mean platelet counts were as follows; head and neck surgeries (210x109/L±75), abdominal surgeries (195x109/L±60), benign tumors (235x109/L±80), malignant tumors (205x109/L±65), general surgery cases (265x109/L±95) and ENT cases (169x109/L±45) (Tables 14, 15 and 16).
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The mean white blood cell count pre operatives (WBC 0) and 1week post operation (WBC 1wk) respectively were as follows; head and neck surgeries had WBC 0 as 5.9x109/L±2 and WBC 1wk as 6.3x109/L±2.2, abdominal surgeries had WBC 0 as 7.1x109/L±3 and WBC 1wk as 8.2 x109/L±2.5, benign tumors had WBC 0 as 8.1x109/L±3 and WBC 1wk as 6.2x109/L±1.5, malignant tumors had WBC 0 as 7.9x109/L±2.2 and WBC 1wk as 8.2x109/L±3, general surgery cases had WBC 0 as 5.6x109/L±1.8 and WBC 1wk as 7.3x109/L±2.5 and ENT cases had WBC 0 as 4.8x109/L±0.8 and WBC 1wk as 5.9x109/L±1.8 (Tables 14, 15 and 16).
The mean pre- and post-operative reticulocyte count (RC 0 and RC 1wk respectively) were as follows; head and neck surgeries had RC 0 as 1.6%±0.3 and RC 1wk as 1.4%±0.2, abdominal surgeries had RC0 as 1.8%±0.4 and RC 1wk as 1.5%±0.5, benign tumors had RC0 as 1.6%±0.4 and RC1wk as 1.3%±0.3, malignant tumors had RC0 as 1.4%±0.2 and RC 1wk as 1.7%±0.4, general surgery cases had RC0 as 1.6%±0.5 and 1wk as 1.5%±0.3, ENT had RC 0 as 1.7% 0.4and RC 1wk as 1.8% ±0.6(Tables 14, 15 and 16).
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Table 14: Haematological parameters of 100 cases that had blood transfusion (Diagnosis by Region).
I.
Diagn. Mean Mean Mean Mean Mean Mean Mean Mean TI (Region) pcv-0 pcv-24hrs pcv-1wk wbc-0 wbc-1wk plt.ct. retic0 retic1wk (%) Head/
Neck 28.5 32.2 33.4 5.4 6.3 210 1.6 1.4 5.2 Thoracic 26.3 31.4 34.2 6.1 4.9 230 1.3 1.6 52.6 Abd 25.1 30.8 35.1 7.1 8.2 195 1.8 1.5 54.3 GUS 27.4 34.5 36.3 5.2 5.9 244 1.3 1.8 58.3 Others 24.2 30.9 32.6 4.9 5.3 165 1.2 1.3 25.6 NB; Diagn = Diagnosis
Mean PCV-0 = Mean pre-operative packed cell volume
Mean PCV-24hrs = Mean 24hours post operative packed cell volume Mean PCV-1wk = Mean 1 week post-operative packed cell volume Mean WBC-0 = Mean pre-operative white blood cell count
Mean WBC-1wk = Mean 1 week post-operative white blood cell count Mean Plt.Ct. = Mean platelet count
Mean RC-0 = Mean pre-operative reticulocyte count Mean RC-1wk = Mean 1week post-operative reticulocyte TI = Transfusion index
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Figure 6.Mean pre-operative PCV (MPCV 0) and transfusion index (TI) in relation to
clinical disorders based on region.
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Table 15. Haematological parameters for 100 cases that had blood transfusion (Diagnosis by Pathology).
Diagn. Mean Mean Mean Mean Mean Mean Mean Mean TI(%) pcv0 pcv24hrs pcv1wk wbc0 wbc1wk plt.ct. rc 0 rc 1wk
Malignant
tumors 29.2 33.5 34.2 7.9 8.2 205 1.4 1.7 29.4 Benign
tumors 23.1 32.3 35.6 8.1 6.2 235 1.6 1.3 66.7 Others 25.3 31.6 33.2 6.3 5.4 190 1.3 1.5 26.0
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Figure 7.Mean pre-operative packed cell volume (M PCV 0) and the transfusion index (TI) in relation to clinical conditions based on pathology.
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Table 16. Haematological parameters for 100 cases that had blood transfusion (Diagnosis by Specialty).
Diagn. Mean Mean Mean Mean Mean Mean Mean Mean TI (Specialty) pcv0 pcv24hrs pcv1wk wbc0 wbc1wk plt.ct rc 0 rc1wk (%) GS 24.3 30.8 32.6 5.6 7.3 265 1.6 1.5 53.0 Urology 26.1 32.1 35.2 6.3 8.1 185 1.9 1.7 40.4 ENT 30.2 33.1 34.2 4.8 5.9 169 1.7 1.8 33.3 Others 29.2 32.4 33.8 6.1 6.6 154 1.7 1.5 25.0
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Figure 8.Pre-operative packed cell volume (M PCV 0) and transfusion index (TI) in relation to clinical conditions based on specialty for the 100 elective surgical cases that had blood transfusion.
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