Abstract
BackgroundPaediatric 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.MethodsA 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.ResultsMedian 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.ConclusionA 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.
Highlights
Paediatric anaemia is a major public health issue in developing countries owing to factors such as nutrition, infections and socioeconomic status
Major surgery category had the highest proportion of children who were transfused and tested for anaemia
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
Summary
Paediatric anaemia is a major public health issue in developing countries owing to factors such as nutrition, infections and socioeconomic status. Anaemia is associated with higher mortality and organ dysfunction post-surgery [1] It can increase length of hospital stay, blood transfusions and intensive care requirements [2]. Preoperative anaemia testing and treatment through patient blood management strategies, including restrictive transfusion, was discussed in our recent literature review [3]. A global partnership between multidisciplinary professionals in the UK and Bangladesh was formed To begin this process, an investigation of current practices was carried out at a major paediatric surgical centre in Bangladesh. An investigation of current practices was carried out at a major paediatric surgical centre in Bangladesh This was done retrospectively from patient records and is described in this paper. Preoperative anaemia testing and transfusion was assessed retrospectively through patient notes
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