Assessment of the clinical transfusion practice at a regional referral hospital in Uganda

Abstract

The aim of this study was to determine the indications for transfusion, blood ordering practices and post-transfusion complications, and to assess the clinical transfusion practice at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda. There are no guidelines on the appropriate use of blood at MRRH. Therefore, there was a need to assess the local clinical transfusion practice. Patients' hospital files were studied for evidence of blood transfusions in 2008. All five wards were reviewed and details on the transfusion process were recorded. A total of 1730 patients (median age, 19.0 years; range, 1 day to 88 years; female-to-male ratio, 1.4), for whom blood was cross-matched, were studied. Of these, 1674 (96.8%) patients actually received transfusions, which were as whole blood in 58.4% of recipients. The mean number of units per recipient was 1.7 and the cross-match-to-transfusion ratio was 1.3. The three most frequent indications for transfusion were malaria (38.8%), bleeding (27.1%) and other infections (16.1%). There were no records for pre-transfusion haemoglobin, compatibility testing, transfusion start-times and vital signs in 30.2, 51.8, 21.5 and 97.6% of the recipients, respectively. Transfusion reactions were recorded for 10 (0.6%) patients. Although there was no evidence of blood wastage, inadequacies were noted in the documentation of the transfusion process. There is a need to train staff in blood transfusion and to design a 'blood transfusion form' for easy monitoring and evaluation. A hospital transfusion committee and guidelines on the appropriate use of blood should be put in place at MRRH.

Estimating Tanzania's National Met and Unmet Blood Demand From a Survey of a Representative Sample of Hospitals

“…The Kampala study also found similar findings including a higher percentage of female transfusion recipients and obstetrics, gynecology, and medical wards as the top users of blood issued. Another Ugandan study from a regional referral hospital found a mean number of 1.7 units requested per recipient, similar to 1.3 units in our study, and also that most patients received WB transfusions [20]. Unlike our study, a study of blood transfusion services at a district hospital in Malawi during 1 month reported a higher percentage of pediatric transfusions (57%) compared with 34% in our study [29], which may be due to our more representative sample of hospitals and seasons.…”

Deformability of Red Blood Cells and Correlation with ATP Content during Storage as Leukocyte-Depleted Whole Blood

“…In most developed countries, LD red cell concentrates resuspended in additive solutions are the state-of-the-art red cell products for allogeneic transfusion. However, the results of this study are still valuable for autologous transfusion and the many clinical settings, particularly in developing countries [35] where allogeneic whole blood is still mainly employed. Furthermore, the use of whole blood is gaining renewed interest in developed countries [36][37][38] because it has been shown that leukocyte depletion results in a considerably improved plasma quality in whole blood [39].…”

The influence of maintaining the correct whole blood‐to‐anticoagulant ratio during donation on the quality of leukoreduced whole blood

“…WB has been the mainstay in blood transfusion for many decades but has nowadays largely been replaced by component transfusion in industrialized countries 22 . However, WB is still being extensively used in autologous transfusion and in allogeneic transfusion in developing countries 9 . In addition, WB has regained interest as the blood product of choice for various clinical situations (see below).…”

“…Second, the quality of WB cannot be addressed using apheresis RBCs. Since WB is still widely used in autologous transfusion, and in many undeveloped countries also in allogeneic transfusions, 9 though, data on the quality of this blood product in particular are needed. Furthermore, WB has gained renewed interest in industrialized countries recently, 10‐12 because it has been shown that leukoreduction results in a considerably improved plasma quality of WB, 13 possibly rendering it suitable particularly for use in massive transfusion settings.…”