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Published on: March 14, 2017
Pediatric blood transfusion practices at a regional referral hospital in Kenya
Helen M Nabwera1,2, Greg Fegan1,3,4, Jay Shavadia5
1Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.
Insights
Severe anemia in Kenyan children often leads to blood transfusions. While most transfusions were appropriate, clinical diagnosis of anemia frequently differed from lab results, impacting blood supply.
Area of Science:
- Pediatrics
- Hematology
- Public Health
Background:
- Severe anemia is a significant public health concern for children in sub-Saharan Africa.
- This study examines blood transfusion practices for pediatric patients at Coast Provincial General Hospital in Kenya.
Purpose of the Study:
- To describe the clinical and operational aspects of blood transfusions in children admitted to a Kenyan hospital.
- To assess the appropriateness of blood transfusion practices and identify challenges in managing severe anemia in pediatric patients.
Main Methods:
- An observational study conducted over two years.
- Collected demographic and laboratory data for all pediatric transfusion requests.
- Retrospectively reviewed case notes for clinical data.
Main Results:
- 2789 blood transfusion requests were made for children (median age 1.8 years).
- 90% of requested blood was presumed transfused, with a median pretransfusion hemoglobin of 6.0 g/dL.
- Significant disagreement existed between clinical and laboratory diagnoses of severe anemia; 52% of transfusions were deemed inappropriate based on clinical impression alone.
Conclusions:
- Clinician's clinical impression of severe anemia often drives transfusion orders, affecting laboratory workload and blood supply.
- Despite diagnostic discrepancies, the majority of children with severe anemia received appropriate transfusions.
- Concurrent prescription of antimalarials with blood transfusions, regardless of blood film results, is a common practice.
Background:
Severe anemia in children is a major public health problem in sub-Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya.
Study Design And Methods:
This was an observational study where over a 2-year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year.
Results:
There were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6-6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4-12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2-9.1 g/dL). Ninety-four percent (186) were transfused "appropriately" while 52% (120) were transfused "inappropriately." There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p < 0.0001). Antimalarials were prescribed for 65% (259) of children who received blood transfusions but only 41% (106) of these had a positive blood film.
Conclusion:
In this setting, clinicians often order blood based on the clinical impression of "severe anemia." This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice.
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