Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study

Dominic Mosha,Anja Poulsen,Ib C Bygbjerg,Hugh Reyburn,Frank Mtei,Elimsaada Kituma

doi:10.1186/1471-2431-9-51

Abstract

BackgroundBlood transfusion (BT) can be lifesaving for children; however, monitoring the quality of BT is important. The current study describes the quality of paediatric BT delivered in two district hospitals in north-east Tanzania in order to identify areas for quality assurance and improvement in the administration of BT.MethodsAll 166 children admitted in the paediatric wards and receiving BT through April to June 2007 were prospectively observed. Medical records, request forms and registers in the laboratories were reviewed to identify blood source, blood screening and indications for BT. BT was observation before, during and after transfusion process.ResultsMalaria related anaemia accounted for 98% of the BTs. Ninety-two percent of the children were assessed for paleness. Clinical signs such as difficult breathing and symptoms of cardiac failure were only assessed in 67% and 15% of the children respectively, prior to the BT decision. Pre-transfusion haemoglobin and body temperature were recorded in 2/3 of the patients, but respiratory rate and pulse rate were not routinely recorded. In 40% of BTs, the transfusion time exceeded the recommended 4 hours.The zonal blood bank (ZBB) and local donors accounted for 10% and 90% of the blood, respectively. ABO and RhD typing and screening for HIV and syphilis were undertaken in all transfused blood. Evidence for hepatitis B or C infection was not checked except in the ZBB.ConclusionCriteria for BT are not always fulfilled; time to initiate and complete the transfusion is often unacceptable long and monitoring of vital signs during BT is poor. Blood from the ZBB was often not available and BT often depended on local donors which implied lack of screening for hepatitis B and C. It is recommended that an external supervision system be established to monitor and evaluate the quality of BT performance in the laboratories as well as in wards.

Highlights

Blood transfusion (BT) can be lifesaving for children; monitoring the quality of BT is important
Each hospital had a laboratory to screen and cross match blood for transfusion. In both hospitals a Hemocue (201+, Hemocue AB, Ängelholm Sweden) was used to measure haemoglobin level. In spite of these risks many children are transfused without meeting standard criteria for transfusion, the most important of which are severe anaemia with respiratory distress or impaired consciousness, conditions associated with mortality between 20–35% [4]
Malaria associated with anaemia accounted for 157 (98%) of the BTs, and only 2% had a diagnosis of marasmus, pneumonia or burn

Summary

Introduction

Blood transfusion (BT) can be lifesaving for children; monitoring the quality of BT is important. For example a Kenyan study found that up to 2% of transfused blood was HIV-infected due to laboratory errors [3]. Each hospital had a laboratory to screen and cross match blood for transfusion. In both hospitals a Hemocue (201+, Hemocue AB, Ängelholm Sweden) was used to measure haemoglobin level. In spite of these risks many children are transfused without meeting standard criteria for transfusion, the most important of which are severe anaemia with respiratory distress or impaired consciousness (symptomatic severe anaemia), conditions associated with mortality between 20–35% [4]

Methods

Results

Discussion

Conclusion