Abstract
BackgroundUnnecessary blood transfusion exposes recipients to potential harms.AimThe aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion.SettingA hospital providing level 1 and 2 services.MethodsA mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviews.ResultsOf 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs.ConclusionMost orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines.
Highlights
While blood transfusion is a life-saving procedure that can improve health outcomes, its unnecessary use exposes recipients to potential hazards, an increased risk of death, increases healthcare costs and reduces blood availability.[1]
Only one red blood cells (RBCs) unit should be transfused at a time in most clinical situations,12,1314 and the patient should be reassessed after a one-unit transfusion before considering further transfusion
A sample was taken of patients transfused at Mthatha Regional Hospital (MRH) in the medical, surgical, gynaecology, obstetrics, paediatrics and emergency departments
Summary
While blood transfusion is a life-saving procedure that can improve health outcomes, its unnecessary use exposes recipients to potential hazards (e.g. infections and transfusion reactions), an increased risk of death, increases healthcare costs and reduces blood availability.[1] The most common blood product transfused is red blood cells (RBCs),[2] and in South Africa, 96% of transfusion recipients receive RBCs.[3] There is evidence of unnecessary RBC transfusion in studies worldwide with prevalence rates of 46% in the United Kingdom,4 21.4% in Spain[5] and 23% in Northern Ireland[6] for adults, and of 55.5% in Uganda[7] and 66% in South Africa for children.[8].
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