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An Observational Study of Paediatric Preoperative Transfusion Practice in a Resource-Limited Setting
Somy Charuvila1, Tasmiah Tahera Aziz2, Sarah E Davidson3
1Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. somysamuel@gmail.com.
Insights
Paediatric preoperative anaemia management in Bangladesh shows a liberal transfusion approach. This study highlights the need for better anaemia testing and patient blood management strategies in resource-limited settings.
Area of Science:
- Paediatric Surgery
- Anaemia Management
- Global Health
Background:
- Paediatric anaemia is common in low-middle-income countries, impacting surgical outcomes.
- No current guidelines exist for managing preoperative paediatric anaemia.
- Understanding current practices is crucial for optimizing care in resource-limited settings.
Purpose of the Study:
- To investigate current practices of preoperative anaemia testing and blood transfusion in paediatric surgical patients in Bangladesh.
- To identify factors influencing transfusion decisions in resource-limited settings.
Main Methods:
- An observational study was conducted at a paediatric surgical center in Bangladesh.
- 464 patients aged ≤16 years undergoing surgery were included and categorized by anticipated blood loss (major, moderate, minor).
- Retrospective review of patient notes assessed preoperative anaemia testing and transfusion rates.
Main Results:
- 32.5% of patients had preoperative anaemia testing; 17.5% received preoperative transfusions.
- 40.7% of transfused children were treated based on clinical signs alone.
- Major surgery patients had the highest rates of testing and transfusion.
Conclusions:
- A liberal blood transfusion approach is currently employed, influenced by challenges in obtaining timely results and laboratory costs.
- Further research into point-of-care haemoglobin testing and patient blood management is recommended to reduce unnecessary transfusions and associated risks.
Background:
Paediatric anaemia is highly prevalent in low-middle-income countries and can negatively impact postoperative outcomes. Currently, there are no guidelines for the management of paediatric preoperative anaemia. To ensure optimal care in resource-limited settings: balancing the risks of anaemia and using resources such as blood transfusion, we first need to understand current practices. To address this, a joint UK-Bangladesh team conducted an observational study at a paediatric surgical centre in Bangladesh.
Methods:
A total of 464 patients ≤16 years who underwent elective and emergency surgery were categorised into major (351/464), moderate (92/464) and minor (21/464) surgery groups according to anticipated blood loss. Preoperative anaemia testing and transfusion was assessed retrospectively through patient notes.
Results:
Median age was 4 years and 73% were male. 32.5% (151/464) patients had preoperative blood testing for anaemia. 17.5% (81/464) children were transfused preoperatively. Of those children transfused, 40.7% (33/81) underwent transfusion solely based on visible signs of anaemia on clinical examination. Seventy-five percentage (36/48) of children who underwent transfusion after blood testing had haemoglobin ≥80 g/L. Major surgery category had the highest proportion of children who were transfused and tested for anaemia.
Conclusion:
A liberal transfusion approach is evident here. Discussion with local clinicians revealed that this was due to limitations in obtaining timely blood results and reduction in laboratory costs incurred by families when clinical suspicion of anaemia was high. Further research is needed to analyse the potential of using bedside haemoglobin testers in conjunction with patient blood management strategies to limit blood transfusions and its associated risks.
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