Blood Transfusion in Transurethral Resection of the Prostate (TURP): A Practice that Can be Avoided

Background: This study was aimed at establishing the determinants of blood transfusion in Transurethral Resection of the Prostate (TURP) at the Kilimanjaro Christian Medical Centre (KCMC) and explore prudent methods of blood use in this urological surgery Methods: This was a one year prospective, hospital based study done at The Kilimanjaro Christian Medical Centre, a 550 bed tertiary centre in the Kilimanjaro region of Tanzania. The study population consisted of 128 of 220 patients who underwent TURP in the year of study. The primary outcome measure was the factors that determine blood transfusion in TURP surgery in KCMC. The secondary outcome measure was the underlying causes leading to blood use and the likely modes that can lead to better use of blood in this urological surgery. Results: One hundred and twenty eight out of 220 patients were transfused, giving a blood transfusion rate of 58.2%. The mean amount of whole blood transfusion was 1.2 units with a range of 1-4 units. The main determinants of blood transfusion were prostate resection greater than 40grams, preoperative Hb less than 11g/dl and the experience of the surgeon. Underlying causes included lack of hospital transfusion protocol and routine autologous donation with a laboratory policy that fails to use the auto-donated blood for other patients who may need it. Conclusion: Inappropriate clinical decisions and lack of hospital blood transfusion protocol are responsible for improper use of available blood. Slightly more than three quarters of the transfusions were unnecessary and indicate that with a proper hospital transfusion protocol, blood transfusion after TURP can be minimized or, with modern approaches like intra-prostatic epinephrine, be done away with altogether. Recommendations: Clinical decisions based on prudent use of blood should be instituted to maximize on its benefits to deserving patients. A hospital policy with adequate laboratory support should be put in place to ensure adequate screening that allows availability of blood to patients in need irrespective of mode of donation.