Appropriateness of blood product transfusion in the Obstetrics and Gynaecology (O&G) department of a tertiary hospital in West Africa

Edward Osei · Alexander T. Odoi · Shirley Owusu‐Ofori · Jean‐Pierre Allain

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Blood donation and transfusion practices Blood transfusion and management Blood groups and transfusion

Abstract

BACKGROUND: Misuse of blood by clinicians was suggested to explain blood shortage in sub-Saharan Africa although based on little evidence. This study evaluated whether routine halving (restricted) of blood requests was justified. STUDY DESIGN AND METHODS: On alternated days for 3 months in 2011-2012, restricted or full blood product supply [whole blood (WB), red cell concentrate (RCC)] was provided to the Obstetrics & Gynaecology department (O&G). Patient age, haemoglobin (Hb) level pre- and post-transfusion, clinical condition, blood products request and supply, transfused and returned, clinical outcome were collated. RESULTS: Five hundred and nineteen patients (249 restricted and 270 full supply) received 1001 blood products (94.6% WB, 6.4% RCC). Clinical conditions were severe peri-partum bleeding (72.4%) requiring emergency transfusion (82%) whilst 27.6% of total transfusion was for anaemia, 18% being moderate (8-10 g dL(-1) ). Pre-transfusion Hb level was <6 g dL(-1) in 36.7%, 6-8 g dL(-1) 29.1% and ≥ 8 g dL(-1) in 33.2% of cases. Fifty-five percent of the transfused blood was stored ≤ 1 week. Restricted supply triggered additional request (40%) compared to 10% in full supply mode. Whether with restricted or full supply, blood requests, supply and units transfused/patient were similar (restricted 2.3 and 2.1 unit patient(-1) and full 2.9 and 2.3 unit patient(-1) , respectively). Fatal clinical outcome was 3.1% evenly distributed between supply modes and transfusion reactions 0.8%. CONCLUSIONS: O&G clinicians order blood according to clinical need and transfuse 85% of the products supplied. Product supply did not significantly affect use although appropriateness of transfusion was difficult to assess.

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References

2008Maternal mortality in sub‐Saharan Africa: the contribution of ineffective blood transfusion services 2011Moving on from voluntary non‐remunerated donors: who is the best blood donor?2012External Financial Aid to Blood Transfusion Services in Sub-Saharan Africa: A Need for Reflection 2007Transfusion in sub-Saharan Africa: does a Western model fit?1993Blood transfusion practices and blood-banking services in a Kenyan hospital 2012Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District 2010Fostering repeat donations in Ghana

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