Abstract
SummaryOwing to the rapid turnaround time in the assessment of haemoglobin level by point-of-care tests (POC Hb), these have grown in popularity and scope in large parts of the world. However, whilst POC testing for malaria and HIV remains has been integrated into patient management in Africa, the use of POC haemoglobin testing remains neglected by health services. The main users of transfusions (paediatric, maternity and trauma services) present largely as emergencies. Ward-based POC Hb could result in more rapid and accurate diagnosis of anaemia, contributing to saving of lives and at the same time reduce unnecessary transfusions which deplete the limited supplies of donated blood in Africa. Severe anaemia requiring transfusion is a major cause of paediatric admission in Africa. At a dissemination meeting to discuss the results of a large phase III paediatric transfusion trial and steps to implementation of the findings participants strongly recommended that one of the most pressing actions required was to prioritise the use of POC haemoglobin testing. This would facilitate implementation of the new transfusion algorithm, developed at the meeting, which refines patient management including blood transfusions. We present the rationale for the strongly recommended prioritisation of POC Hb, using paediatric transfusion as an exemplar.
Highlights
We report on the aspect that was agreed to be a major barrier to effective implementation: timely access to initial and repeated haemoglobin testing in children with suspected severe anaemia
There may have been other reasons for the worse outcome in those not receiving a transfusion in this study, we have previously shown that many severely anaemic children (
This includes a community study conducted in healthy children in Tanzania and Mozambique demonstrating a prevalence of mild (80–110 g/l) and moderate anaemia (
Summary
Owing to the rapid turnaround time in the assessment of haemoglobin level by point-of-care tests (POC Hb), these have grown in popularity and scope in large parts of the world. If this potential barrier for blood transfusions services would be addressed, and if the results of the trial were adopted, a triggered transfusion strategy would reduce blood requirements in the group of children with uncomplicated severe anaemia by ~60% compared to immediate transfusion, preserving blood transfusion supplies for emergencies This finding is important in settings like those where the TRACT trial was conducted, where shortages of donor blood are still frequent,[10] despite a decade or more of increased external aid to support blood transfusion services.[11] a triggered transfusion strategy is considerably less costly for the health services than immediate transfusions despite the longer length of stay in hospital (around 24 h, on average).[8] Overall, 28day mortality (
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