Appropriateness of blood product transfusion in the Obstetrics and Gynaecology (O&G) department of a tertiary hospital in West Africa

摘要

SUMMARY: Background: Misuse of blood by clinicians was suggested to explain blood shortage in sub-Saharan Africa although based on little evidence. This study evaluated whether routine halving (restricted) of blood requests was justified. Study design and methods: On alternated days for 3months in 2011-2012, restricted or full blood product supply [whole blood (WB), red cell concentrate (RCC)] was provided to the Obstetrics & Gynaecology department (O&G). Patient age, haemoglobin (Hb) level pre- and post-transfusion, clinical condition, blood products request and supply, transfused and returned, clinical outcome were collated. Results: Five hundred and nineteen patients (249 restricted and 270 full supply) received 1001 blood products (94·6% WB, 6·4% RCC). Clinical conditions were severe peri-partum bleeding (72·4%) requiring emergency transfusion (82%) whilst 27·6% of total transfusion was for anaemia, 18% being moderate (8-10gdL-1). Pre-transfusion Hb level was 6gdL-1 in 36·7%, 6-8gdL-1 29·1% and ≥8gdL-1 in 33·2% of cases. Fifty-five percent of the transfused blood was stored ≤1week. Restricted supply triggered additional request (40%) compared to 10% in full supply mode. Whether with restricted or full supply, blood requests, supply and units transfused/patient were similar (restricted 2·3 and 2·1unitpatient-1 and full 2·9 and 2·3unitpatient-1, respectively). Fatal clinical outcome was 3·1% evenly distributed between supply modes and transfusion reactions 0·8%. Conclusions: O&G clinicians order blood according to clinical need and transfuse 85% of the products supplied. Product supply did not significantly affect use although appropriateness of transfusion was difficult to assess.