Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda

Area of Science:

• Hematology
• Critical Care Medicine
• Global Health

Background:

• Restrictive blood transfusion guidelines are established in high-income countries (HIC).
• Optimal transfusion thresholds in low- and middle-income countries (LMIC) remain undetermined due to differing anemia etiologies and patient health statuses.
• This study investigates packed red blood cell (PRBC) transfusion associations with mortality in Rwandan emergency center (EC) patients.

Purpose of the Study:

• To evaluate the association between PRBC transfusion and mortality outcomes in medical patients presenting to an emergency center in Kigali, Rwanda.
• To determine optimal hemoglobin thresholds for PRBC transfusion in a LMIC setting.
• To compare transfusion practices and outcomes between LMIC and HIC.

Main Methods:

• A retrospective cohort study of 1116 adult patients treated for medical emergencies at the University Teaching Hospital of Kigali between 2013 and 2016.
• Logistic regression analysis was used to assess the relationship between PRBC transfusion and mortality.
• Stratified analyses were performed at hemoglobin levels of 7 mg/dL and 5 mg/dL.

Main Results:

• PRBC transfusion occurred in 12.1% of patients, primarily for hematologic (24.4%) and gastrointestinal (20.7%) conditions.
• Overall mortality was higher in transfused patients (23.7%) versus non-transfused (17.0%), though not statistically significant (p=0.06).
• Patients receiving EC transfusions with hemoglobin >5.0 mg/dL had 2.21 times the odds of mortality compared to those with hemoglobin ≤5.0 mg/dL.

Conclusions:

• PRBC transfusion was not associated with mortality in this LMIC emergency center cohort.
• Transfusing patients with hemoglobin >5 mg/dL was associated with increased mortality.
• Findings suggest limited benefits of PRBC transfusion compared to HIC, necessitating further research on transfusion thresholds in LMICs.