Pediatric blood transfusion practices at a regional referral hospital in Kenya
AFRICAN CHILDREN
Male
Transfusion Practice
610
Practice Patterns
TRANSMITTED MALARIA
1102 Cardiovascular Medicine And Haematology
618
03 medical and health sciences
0302 clinical medicine
Humans
Blood Transfusion
ANEMIA
Practice Patterns, Physicians'
Preschool
KILIFI
Child
Referral and Consultation
Retrospective Studies
Physicians'
Science & Technology
MORTALITY
Infant
1103 Clinical Sciences
Anemia
Hematology
RECOVERY
Kenya
3. Good health
Cardiovascular System & Hematology
1107 Immunology
Child, Preschool
Blood Banks
Female
Life Sciences & Biomedicine
DOI:
10.1111/trf.13774
Publication Date:
2016-09-09T15:15:41Z
AUTHORS (8)
ABSTRACT
BACKGROUNDSevere anemia in children is a major public health problem in sub‐Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya.STUDY DESIGN AND METHODSThis was an observational study where over a 2‐year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year.RESULTSThere were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6‐6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4‐12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2‐9.1 g/dL). Ninety‐four percent (186) were transfused “appropriately” while 52% (120) were transfused “inappropriately.” There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p < 0.0001). Antimalarials were prescribed for 65% (259) of children who received blood transfusions but only 41% (106) of these had a positive blood film.CONCLUSIONIn this setting, clinicians often order blood based on the clinical impression of “severe anemia.” This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice.
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