Haematological quality and age of donor blood issued for paediatric transfusion to four hospitals in sub-Saharan Africa.
Anemia
/ blood
Blood Banks
/ standards
Blood Donors
Blood Transfusion
/ methods
Child
Hematocrit
Hematology
/ standards
Hemoglobins
Hospitals
Humans
Malawi
Pediatrics
/ methods
Quality Assurance, Health Care
Quality Control
Randomized Controlled Trials as Topic
Refrigeration
Reproducibility of Results
Specimen Handling
Uganda
anaemia
blood transfusion services
donor blood pack
haematocrit
haemoglobin
Journal
Vox sanguinis
ISSN: 1423-0410
Titre abrégé: Vox Sang
Pays: England
ID NLM: 0413606
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
01
10
2018
revised:
28
12
2018
accepted:
28
01
2019
pubmed:
7
3
2019
medline:
23
7
2019
entrez:
7
3
2019
Statut:
ppublish
Résumé
Paediatric blood transfusion for severe anaemia in hospitals in sub-Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes. We undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi). The overall distribution of whole blood, packed cells (plasma-reduced by centrifugation) and red cell concentrates (RCC) (plasma-reduced by gravity-dependent sedimentation) used in a randomised trial was 40·7% (N = 1215), 22·4% (N = 669) and 36·8% (N = 1099), respectively. The first audit found similar median haematocrits of 57·0% (50·0,74·0), 64·0% (52·0,72·5; P = 0·238 vs. whole blood) and 56·0% (48·0,67·0; P = 0·462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re-training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18·2% (537/2964) over 21 days in storage. Initially, 9 (2·8%) packs were issued past the recommended duration of storage, dropping to 0·3% (N = 7) in the third audit post-training. The study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Paediatric blood transfusion for severe anaemia in hospitals in sub-Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes.
MATERIALS AND METHODS
METHODS
We undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi).
RESULTS
RESULTS
The overall distribution of whole blood, packed cells (plasma-reduced by centrifugation) and red cell concentrates (RCC) (plasma-reduced by gravity-dependent sedimentation) used in a randomised trial was 40·7% (N = 1215), 22·4% (N = 669) and 36·8% (N = 1099), respectively. The first audit found similar median haematocrits of 57·0% (50·0,74·0), 64·0% (52·0,72·5; P = 0·238 vs. whole blood) and 56·0% (48·0,67·0; P = 0·462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re-training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18·2% (537/2964) over 21 days in storage. Initially, 9 (2·8%) packs were issued past the recommended duration of storage, dropping to 0·3% (N = 7) in the third audit post-training.
CONCLUSION
CONCLUSIONS
The study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.
Identifiants
pubmed: 30838664
doi: 10.1111/vox.12764
pmc: PMC6563499
doi:
Substances chimiques
Hemoglobins
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
340-348Subventions
Organisme : Medical Research Council
ID : MC_UU_12023/17
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12023/26
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/J012483/1
Pays : United Kingdom
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2019 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.
Références
MMWR Morb Mortal Wkly Rep. 2011 Nov 25;60(46):1577-82
pubmed: 22108537
Trials. 2015 Dec 29;16:593
pubmed: 26715196
N Engl J Med. 2015 Apr 9;372(15):1419-29
pubmed: 25853746
Transfus Med Rev. 2012 Apr;26(2):164-80
pubmed: 21872426
BMC Res Notes. 2015 Oct 19;8:583
pubmed: 26480855
Transfusion. 2011 Apr;51(4):894-900
pubmed: 21496052
Transfusion. 2009 Dec;49(12):2594-8
pubmed: 19682331
BMC Med. 2015 Feb 02;13:21
pubmed: 25640706
Br J Haematol. 2013 Nov;163(3):303-14
pubmed: 24032719
Proc Natl Acad Sci U S A. 2007 Oct 23;104(43):17063-8
pubmed: 17940021
BMJ. 2015 Mar 24;350:h1354
pubmed: 25805204
PLoS Med. 2012;9(9):e1001309
pubmed: 22984355
N Engl J Med. 2007 Apr 19;356(16):1609-19
pubmed: 17442904
Transfus Med Rev. 2018 Apr;32(2):77-88
pubmed: 29526337
MMWR Morb Mortal Wkly Rep. 2008 Nov 28;57(47):1273-7
pubmed: 19037194
N Engl J Med. 2015 Apr 9;372(15):1410-8
pubmed: 25853745
N Engl J Med. 2017 Nov 9;377(19):1858-1867
pubmed: 28952891
JAMA. 2015 Dec 15;314(23):2514-23
pubmed: 26637812
N Engl J Med. 1999 Feb 11;340(6):409-17
pubmed: 9971864