High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Robert O Opoka,James K Tumwine,Andrew S Ssemata,Charles Karamagi,Chandy C John,William Oyang,Harriet Nambuya

doi:10.1186/s12913-018-3382-5

Robert O Opoka, James K Tumwine + Show 5 more

Open Access

https://doi.org/10.1186/s12913-018-3382-5

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Abstract

BackgroundSevere anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda.MethodsInpatient records of children 0–5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of ‘severe anemia’. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals.ResultsOverall, 574/2275 (25.2%) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9%) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4%) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5%) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5%) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9%) vs. 22 (7.2%), [OR 0.4, 95% CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb.ConclusionMore than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.

Highlights

Severe anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown
We describe the extent of appropriateness of use of blood transfusion in children admitted with a diagnosis of severe anemia in two regional referral hospitals in northern and eastern Uganda
In this study we found a disturbingly high rate of inappropriate use of blood transfusion in the management of anemic children in two referral hospitals in Uganda

Summary

Introduction

Severe anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. Severe anaemia (SA), is a common public health problem in resource limited settings, especially in children under 5 years of age. It accounts for 9.7–29% of total paediatric admissions and 8–17% of hospital deaths in sub-Saharan Africa [1,2,3,4,5,6]. Regardless of the cause, appropriate management involves laboratory confirmation of severity of hemoglobin (Hb) level and prompt correction of the severe anemia by blood transfusion [9]. In most resource limited settings a threshold Hb of ≤ 6.0 g/dL is used for transfusion [10]

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