Use of clinical judgement to guide administration of blood transfusions in Malawi

The aim of this study was to investigate whether clinicians in Malawi could use clinical judgement alone to administer blood transfusions in accordance with guidelines. Clinicians at a district hospital did not use the Lovibond Comparator haemoglobin results provided by their laboratory as they felt them to be unreliable, preferring instead to rely on their clinical judgement alone to guide transfusion practice. Their transfusion practice and the Lovibond haemoglobin results were monitored against the World Health Organization recommended haemiglobincyanide method for haemoglobin measurement without the clinicians having access to this result. The Lovibond Comparator method was shown to have a sensitivity of only 21% to detect trigger haemoglobin values for transfusion published in local guidelines. Without access to a useful haemoglobin result, clinicians gave 67% of transfusions in accordance with the haemoglobin trigger values in the guidelines. This study shows that clinical features alone can provide a reasonable guide about the need for transfusion, and that poor quality laboratory tests limit the effectiveness of transfusion guidelines.