Abstract
Background and ObjectivesPaediatric blood transfusion for severe anaemia in hospitals in sub‐Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes.Materials and MethodsWe undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi).ResultsThe overall distribution of whole blood, packed cells (plasma‐reduced by centrifugation) and red cell concentrates (RCC) (plasma‐reduced by gravity‐dependent sedimentation) used in a randomised trial was 40·7% (N = 1215), 22·4% (N = 669) and 36·8% (N = 1099), respectively. The first audit found similar median haematocrits of 57·0% (50·0,74·0), 64·0% (52·0,72·5; P = 0·238 vs. whole blood) and 56·0% (48·0,67·0; P = 0·462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re‐training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18·2% (537/2964) over 21 days in storage. Initially, 9 (2·8%) packs were issued past the recommended duration of storage, dropping to 0·3% (N = 7) in the third audit post‐training.ConclusionThe study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.
Highlights
The availability of safe blood for transfusion is fundamental for every healthcare system
We found that three pack types produced by local blood transfusion services (BTS) were supplied for use in the trial: (1) whole blood, collected from donors and stored without any preparation; (2) packed cells, produced by centrifugation, to removal platelets and plasma, followed by the addition of sodium, adenine, glucose and mannitol (SAGM) solution; and (3) ‘red cell concentrates’ (RCCs), which were supplied in Uganda only
RCCs were produced by gravity-dependent sedimentation as an alternative to centrifugation because of limited capacity for mechanical separation
Summary
The availability of safe blood for transfusion is fundamental for every healthcare system. Quality-assurance practices are a legal requirement for blood transfusion services (BTS) in high-income countries to minimize patient risk. Even within this context the prolonged storage of donor blood remains controversial [1,2,3], since transfusions given to critically ill patients with longer storage age have resulted in unintended, adverse consequences [1, 4, 5]. Reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes
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