Analysis of transfusion therapy during the March 2019 mass shooting incident in Christchurch, New Zealand.

BACKGROUND AND OBJECTIVE: A mass casualty incident occurred in Christchurch in March 2019. Thirty-seven patients with gunshot wounds were admitted. We describe and analyse the transfusion management of these casualties. METHODS: Data on demographics, injury and laboratory characteristics, and transfusions are summarized using descriptive statistics. Relationships between variables are examined using Pearson's and Spearman's rank correlations. Univariate analysis of explanatory variables is performed to determine the best early predictors of transfusion requirements. The characteristics of massive transfusion and non-massive transfusion cases are compared using the t- and Mann-Whitney tests. RESULTS: Sixty-five per cent received transfusions. Initial Hb, platelet counts and clotting results were mostly normal. On average, each gunshot wound patient was transfused 4, 3·1, 1·2 and 0·4 units of RBC, FFP, cryoprecipitate and platelets, respectively, on the day. Base excess was the single best predictor of transfusion requirements. CONCLUSIONS: A greater proportion of those with gunshot wounds in this incident were transfused than in other such incidents. Transfusion requirements for patients varied but were generally modest. Blood component transfusion ratios were close to that recommended. The role of base excess as a predictor of transfusion requirements in patients with similar injuries needs more study.

Incidence of maternal sensitisation to Rh(D) in Christchurch, New Zealand and reasons for prophylaxis failures.

AIM: To estimate the current incidence of maternal sensitisation to Rh(D) and examine reasons for prophylaxis failures. METHOD: Retrospective chart review of new sensitisations to Rh(D) detected in antenatal records, between 2005 and 2012 in Christchurch, New Zealand and systematic examination of circumstances likely to have caused prophylaxis failures. RESULTS: Fifty-four new sensitisations in an at-risk population of about 4624 in 8 years means an incidence of roughly 1.1%. In 86.6% of 45 sensitisations where information was available, there was a recognised sensitising event including previous deliveries while in 13.3% there were none. Of those with recognised sensitising events, 46.1% had anti-D prophylaxis per local guidelines, in 12.8%, prophylaxis was given though it did not conform, entirely, to guideline. No prophylaxis at all was given to 41% despite a sensitising event being recognised. CONCLUSION: The incidence of maternal sensitisation to Rh(D) in Christchurch, New Zealand, is as expected given our prophylaxis regimen. Half the sensitisations were associated with complete or partial failure to follow local guidelines. Better adherence to this may reduce incidence of sensitisation. It is also thrice as high as might be expected with a routine antenatal anti-D prophylaxis (RAADP) program. An economic analysis of RAADP in New Zealand will be useful.