Assessment of clinical blood transfusion practice at the Mother and Child Centre-Chantal Biya Foundation Yaounde

Pediatrics, University of Yaounde I
June, 2018


Every year, 112.5 million blood donations are collected globally with half of these done in the high income countries where only 19% of the world's population lives. In Cameroon, 400,000 bags of blood are needed yearly for the treatment of patients in hospitals with the deficit in voluntary blood donations being in the neighbourhood of about 350,000 bags. To manage the supply and use of blood worldwide, the World Health Organisation (WHO) placed pertinent recommendations for blood safety and clinical use. We found some studies in Cameroon which assessed part of the clinical practice in blood transfusion specifically blood transfusion indications but documentation is scarce on a complete assessment of blood transfusion clinical practice. The greatest prevalence of blood transfusions in Cameroon is in children, yet the appropriateness of the practice has been scarcely assessed.
In this hospital based study, we had as aim to describe and assess the pattern of blood transfusion practice in children with international recommendations.
We carried out a descriptive cross sectional study in a Paediatric tertiary hospital. A pretested designed data collection tool was used and every child less than 20 years of age prescribed a transfusion at the hospital was recruited. The transfusions were observed by the investigator up to the end of transfusions and records taken. Data was also collected from medical records, blood request forms, blood tubes and monitoring sheets. The transfusions were timed from their indication up to the end of process. The data collected was entered on CS-Pro 7.1 and analysed on SPSS version 20.0. Cut off statistical significance was set at 0.1.
During the study, 197 transfusions were observed with a predominance of males at 67% and of age group >1year-5years at 35.5%. The average number of transfusions per patient was 1.2. Severe malaria and cancer were the main diagnosis among those transfused at 36.5% and 18.3% respectively. The most frequent indication stated on blood request form was severe anaemia (80.7 %) with no mention of Hb value or any other statement to justify transfusion. The relevant pre-transfusion blood value was recorded in 93.9% of the medical records. Cardiac failure was assessed in 77.2 % of medical records. At least two vital signs were taken before transfusion in 81.7% of patients. Post-transfusion evaluation was hardly ever done immediately transfusion ended (5.1%). Delay of initiation from indication time was at an average of 9.8 hours. There were 52.8% of transfusions which exceeded 4 hours. Transfusion Transmissible Infections (TTIs) were found in 1% of blood bags retested at hospital. The volume of blood discarded was 32903ml equivalent to over 65 blood bags of 500ml. Transfusion indications were appropriate in 70.1% of patients though they were hardly ever clearly stated on blood request forms. The type of blood product demanded was always appropriate and the volume demanded appropriate in 69.5% of patients. Blood request forms were never appropriate and pre-transfusion blood sample was appropriately labelled in 2.1%. The conformity check at hospital was nearly always done appropriately at 98%. The monitoring was never done appropriately and medical record was appropriately filled for just 1 (0.5%) transfusion. For the cases where there was an adverse transfusion reaction, there was 80% appropriateness in management.
Our blood transfusion clinical practice still leaves much to be expected as there is still very low appropriateness in many aspects. Though transfusion indications seem to have improved, there are still suboptimal. Blood wastage in Cameroon is still very high and monitoring of transfusions is always inappropriate.
We recommend that the national guidelines be revised to meet up with international recommendations. Health personnel should be trained regularly to meet up with international standards. There is also the need to review blood transfusion practice regularly and if medical records are appropriately filled, this could even be done retrospectively. We recommend, given the presence of TTIs in blood bags retested, that studies be carried out on a larger scale to better explore this finding.