Cheema B., Molyneux E.M., Emmanuel J.C., M'Baya B., Esan M., Kamwendo H., Kalilani-Phiri L., Boele Van Hensbroek M.
Division of Emergency Medicine, University of Cape Town, Private Bag X24, Bellville, Cape Town 7535, South Africa; College of Medicine, University of Malawi, Blantyre, Malawi; Blood Transfusion Medicine Specialist Consultant, Zimbabwe; Malawi Blood Transfusion Service, Blantyre, Malawi; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Queen Elizabeth Central Hospital, Blantyre, Malawi; Global Child Health Group, Emma Children's Hospital, University of Amsterdam, Netherlands
Cheema, B., Division of Emergency Medicine, University of Cape Town, Private Bag X24, Bellville, Cape Town 7535, South Africa; Molyneux, E.M., College of Medicine, University of Malawi, Blantyre, Malawi; Emmanuel, J.C., Blood Transfusion Medicine Specialist Consultant, Zimbabwe; M'Baya, B., Malawi Blood Transfusion Service, Blantyre, Malawi; Esan, M., Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Kamwendo, H., Queen Elizabeth Central Hospital, Blantyre, Malawi; Kalilani-Phiri, L., College of Medicine, University of Malawi, Blantyre, Malawi; Boele Van Hensbroek, M., Global Child Health Group, Emma Children's Hospital, University of Amsterdam, Netherlands
Severe anaemia is a common childhood emergency in developing countries. Practical evidence-based guidance on when to transfuse, volume of transfusion and ideal duration of transfusion is lacking. The aim of this study is to develop a paediatric transfusion protocol for use in under-resourced environments and evaluate its usability in a busy African hospital setting. A paediatric transfusion protocol based on the WHO Guidelines was developed for the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. On the basis of simple bedside clinical features of respiratory, cardiovascular and neurological compromise, the protocol allocates children with severe anaemia (haemoglobin ≤ 6 g dL-1) to one of the three groups: complicated anaemia, uncomplicated anaemia and anaemia with severe malnutrition. Data were collected to monitor protocol adherence, delays to transfusion, post-transfusion haemoglobin and need for repeat transfusion. Two-hundred and fifteen severely anaemic children were enrolled: 180 complicated, 25 uncomplicated and 10 severely malnourished. With respect to protocol adherence, all children were allocated to the correct transfusion group; correct volume (±10%) was given in 89·3%; correct duration (±30 min) in 86·2% and correct overall rate (±10%) in 78·6%. Comparing old and new transfusion guidelines, a potential avoidable transfusion rate of 29% was found. This study demonstrates that clear and detailed transfusion guidelines based on simple bedside clinical features can be used in a very busy children's hospital in sub-Saharan Africa. With minimal additional equipment, volume and duration of transfusion can be well controlled. Furthermore, having a protocol in place results in a significant reduction of avoidable transfusions. © 2010 British Blood Transfusion Society.
antibiotic agent; hemoglobin; quinine; steroid; adolescent; Africa; anemia; article; blood transfusion; cardiovascular disease; child; clinical feature; development; disease severity; environment; evaluation; female; hospital; human; human cell; human tissue; infant; major clinical study; Malawi; male; malnutrition; monitoring; neurologic disease; patient compliance; pediatric blood transfusion protocol; pediatrics; preschool child; repeat procedure; respiratory tract disease; school child; therapy delay; treatment duration; world health organization; anemia; blood transfusion; cohort analysis; comorbidity; emergency health service; malaria; malnutrition; pediatrics; practice guideline; procedures; prospective study; public hospital; standards; statistics and numerical data; treatment outcome; utilization; Adolescent; Africa; Anemia; Blood Transfusion; Child; Child, Preschool; Cohort Studies; Comorbidity; Emergency Service, Hospital; Female; Guideline Adherence; Hospitals, Public; Humans; Infant; Malaria; Malawi; Male; Malnutrition; Pediatrics; Practice Guidelines as Topic; Prospective Studies; Treatment Outcome
