Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study

Abstract

BackgroundBlood transfusion (BT) can be lifesaving for children; however, monitoring the quality of BT is important. The current study describes the quality of paediatric BT delivered in two district hospitals in north-east Tanzania in order to identify areas for quality assurance and improvement in the administration of BT.MethodsAll 166 children admitted in the paediatric wards and receiving BT through April to June 2007 were prospectively observed. Medical records, request forms and registers in the laboratories were reviewed to identify blood source, blood screening and indications for BT. BT was observation before, during and after transfusion process.ResultsMalaria related anaemia accounted for 98% of the BTs. Ninety-two percent of the children were assessed for paleness. Clinical signs such as difficult breathing and symptoms of cardiac failure were only assessed in 67% and 15% of the children respectively, prior to the BT decision. Pre-transfusion haemoglobin and body temperature were recorded in 2/3 of the patients, but respiratory rate and pulse rate were not routinely recorded. In 40% of BTs, the transfusion time exceeded the recommended 4 hours.The zonal blood bank (ZBB) and local donors accounted for 10% and 90% of the blood, respectively. ABO and RhD typing and screening for HIV and syphilis were undertaken in all transfused blood. Evidence for hepatitis B or C infection was not checked except in the ZBB.ConclusionCriteria for BT are not always fulfilled; time to initiate and complete the transfusion is often unacceptable long and monitoring of vital signs during BT is poor. Blood from the ZBB was often not available and BT often depended on local donors which implied lack of screening for hepatitis B and C. It is recommended that an external supervision system be established to monitor and evaluate the quality of BT performance in the laboratories as well as in wards.

Documentation of the Clinical Blood Transfusion Practice at a Teaching and Referral Hospital in Western Kenya

“…In regards to the documentation of the duration of the blood transfusion, completion of the transfusion was more than the recommended time of 4 hours in 13.0% of the patients. This finding differs from that of studies by Reis (3) and Mosha [11]., where the duration of the transfusion was more than the recommended time in 8% and 40% of the recipients respectively. However, in our study, 57% of the recipients did not have any documentation of the start times of the transfusion.…”

“…The main reason for the delay was lack of blood in the blood bank. In their study, Mosha [11]. found that 8% of patients had to wait for more than 6 hours from the doctor's decision for a blood transfusion to the actual initiation of it due to lack of blood.…”

Blood use in sub‐Saharan Africa: a systematic review of current data

“…Blood use among the other patient populations of pediatrics, obstetrics and gynecology, cesarean section births, and newborns are shown in Appendices S3.3 through S3.7. The studies among pediatric patients showed that 64% (2810 of 4387) of blood products were transfused for malaria. Postpartum hemorrhage (PPH) at 24% (524 of 2228) and cesarean sections at 22% (485 of 2228) were the most transfused diagnostic categories among the obstetrics and gynecology patients, with abortions and cancer accounting for only 10% and 8% of transfusions, respectively.…”

Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania

“…7 Several studies assessing blood demand in sub-Saharan Africa, which consists mainly of low-and middle-income countries, have shown that the majority of blood transfusions were requested for pregnancy-related conditions and complications 13,14 and malaria. [13][14][15][16][17][18] However, the existing literature is generally limited to studies based in specific medical specialties or wards, 17,[19][20][21][22] single hospitals, [13][14][15][23][24][25][26] or a few hospitals in a region of a country. 18,27 Only one study to date has assessed diagnoses driving blood use in a sub-Saharan country on a national level.…”

“…[13][14][15][16][17][18] However, the existing literature is generally limited to studies based in specific medical specialties or wards, 17,[19][20][21][22] single hospitals, [13][14][15][23][24][25][26] or a few hospitals in a region of a country. 18,27 Only one study to date has assessed diagnoses driving blood use in a sub-Saharan country on a national level. 28 No study has been published regarding the appropriate use of blood across an entire African national health care system; however, studies on a smaller scale in Africa have repeatedly demonstrated that a proportion of blood transfusions are unnecessary or inappropriate.…”