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Blood Transfusion Requirements Among War Casualties in Sarajevo

Published online by Cambridge University Press:  28 June 2012

Mirza Begovic ,
Damir Mazlagic ,
Slavenka Straus  and
Brankica Mazlagic
Mirza Begovic*
Affiliation:
Department of Transfusiology, State Hospital of Sarajevo, Sarajevo, Bosnia and Herzegovina
Damir Mazlagic
Affiliation:
Department of Surgery, State Hospital of Sarajevo, Sarajevo, Bosnia and Herzegovina
Slavenka Straus
Affiliation:
Department of Surgery, State Hospital of Sarajevo, Sarajevo, Bosnia and Herzegovina
Brankica Mazlagic
Affiliation:
Department of Surgery, State Hospital of Sarajevo, Sarajevo, Bosnia and Herzegovina
*
Principal Investigator, Disaster Reanimatology Study Group, International Resuscitation Research Center, Department of Anesthesiology/CCM, University of Pittsburgh, Pittsburgh, PA 15260USA
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Abstract

Introduction:

The safe and timely provision of blood is of crucial importance in the prevention and mitigation of morbidity and mortality due to trauma. The use of blood in the treatment of war casualties, soldiers as well as civilians, was analyzed retrospectively and the impact of massive blood transfusion on blood banking services and reserves of blood during the war in Sarajevo was assessed.

Methods:

A retrospective analysis of 3,215 war casualties (1,815 civilians plus 1,400 military) who arrived to the casualty reception center of the State Hospital of Sarajevo during the period 11 May through 31 October 1992 was performed. Blood usage was reviewed in three stages: within 24 hours (h) of admission, after seven days of hospitalization, and after 30 days of hospitalization. The types of injury, survival rate, and blood-usage rate in a sample of 37 war casualties who required massive blood transfusions (MBT) during the period 11 May through 31 December 1992 was examined.

Results:

The civilian casualty rate in this series of patients was 56.5%. A total of 1,217/3,215 (37.9%) casualties were hospitalized. In this study, 16% (504/3,215) of total number of persons wounded received blood transfusion. Of these patients, 504/1,217 (41.4%) were transfused. A total of 971.1 liters of blood were transfused through 31 October 1992; 68% within 24 h of admission, 91% within the first seven days, and 100% within the first 30 days. From a total of 37 MBT recipients, 36 (97%) were injured by firearms. Survival rate among MBT patients was 30%. The MBT recipients comprised 2% of total hospitalized patients and 6% of total number of patients transfused. The amount of blood needed during episodes of MBT was 15% of total blood used through 31 December 1992.

Conclusions:

Based on these data, prospective requirements for blood usage should take into account casualty triage, as follows: for each casualty transported to the hospital, hospitalized, or transfused, 0.302, 0.796, and 1.912 liters of blood respectively, will be needed for the first 30 days of treatment. Recipients of massive blood transfusions are a significant drain on blood reserves in war. This experience can be utilized in the development of revised guidelines for blood usage for an entire population affected by war.

Keywords

blood bankingblood salvageblood supplydisaster medicinehemorrhagehemorrhagic shockhypovolemiamassive blood transfusionmilitary medicinetransfusiologytraumawarwar casualties
Type
Invited Papers
Information
Prehospital and Disaster Medicine , Volume 9 , supplement S1: Invited Papers from Sarajevo , June 1994 , pp. S20 - S24
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

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References

1. Radovic, M, Vojvodic, V: Snabdevanje krvlju, albuminom i infuzijskim rastvorimau ratu. Vojnosanit Pregl 1991;48:195–200.Google Scholar
2. Buffat, JJ: Le choc traumatique de l'avant. Med Armees 1986;14:401–408.Google Scholar
3. Fahre, G: Ravitaillement en Sang et Derives en Campagne. Rev Int Serv Sante Forces Armees 1989;62:144–148.Google Scholar
4. Daum, J: Supplying armed forces with blood. Med Corps Int 1986;1:22–26.Google Scholar
5. Williams, JG: Resuscitation experience in the Falkland Islands campaign. Br Med J 1983;286:775–777.CrossRefGoogle ScholarPubMed
6. Radovic, M, Taseski, J: Sluzba za transfuziju krvi i raiovi. Vojnosanit Pregl 1979;36:359–364.Google Scholar
7. Radovic, M: Prilog organizaciji snabdevanja krvlju, hemoproduktima i rastvorima za infuziju sanitetskih jedinic a i ustanova Jugoslovenske narodne armije u opstenarodnom odbrambenom ratu. Vojnosanit Pregl 1984;41:54–57.Google Scholar
8. Mendelson, JA: The use of whole blood and blood volume expanders in U.S. military facilities in Vietnam 1966-1971. J Trauma 1975;15:1–13.CrossRefGoogle Scholar
9. Silberstein, LE, Kruskall, MS, Stehling, LC et al. : Strategies for the review of transfusion practices. JAMA 1989;262:1993–1997.CrossRefGoogle ScholarPubMed
10. Sawyer, PR, Harrison, CR: Massive transfusion in adults: Diagnoses, survival and blood banking support. Vox Sang 1990;58:199–203.Google ScholarPubMed
11. Widmann, FK, Snyder, EI et al. : Technical Manual of the American Association of Blood Banks. 9th ed. Basel: S Karger, 1984.Google Scholar
12. Genetet, B, Andreu, G, Bidet, JM: Aide-memoire de transfusion. Flammarion medecine-sciences. Paris, 1984.Google Scholar
13. Begovic, M: Organizacija rada i funkcionisanje sluzbe za transfuziju krvi Drzavne bolnice “Sarajevo” u ratnim uslovima. Bilten Drzavne bolnice “Sarajevo,” 1992;1:6–7.Google Scholar
14. Begovic, M, Kozlicic, A: Transfusion therapy during war and peace in Sarajevo, Prehospital and Disaster Medicine, 1994;9:s16–s19.CrossRefGoogle ScholarPubMed
15. Begovic, M: Znacaj masivne transfuzije krvi u ratnim uslovima. Bilten Drzavne bolnice “Sarajevo,” 1992;1:7–8.Google Scholar
16. Harigan, C, Lucas, CE, Ledgerwood, AM: The effect of hemorrhagic shock on the clotting cascade in injured patients. J Trauma 1989;29:1416–1422.CrossRefGoogle Scholar
17. Ratna hirurgija. Beograd: Vojnoizdavacki zavod, 1980.Google Scholar
18. Leikola, J: How much blood for the world? Vox Sang 1988;54:1–5.Google ScholarPubMed