Haematological quality and age of donor blood issued for paediatric transfusion to four hospitals in sub‐Saharan Africa

Abstract

Background and Objectives 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 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 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 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.

Co-trimoxazole or multivitamin multimineral supplement for post-discharge outcomes after severe anaemia in African children: a randomised controlled trial

“…Although in the protocol, we were unable to obtain haemoglobin concentration at discharge for most children because many parents refused this test after children recovered. the substantial increases in haemoglobin concentration from 48 h to 28 days post admission (appendix pp [16][17] makes it difficult to assess the optimal time for future interventions to target. We did not have funding to estimate micronutrient deficiencies at baseline.…”

“…Training and basic infrastructural support for emergency care, bedside capillary haemoglobin (HemoCue Hb301 which was quality-controlled daily), glucose and lactate point-of-care tests, and patient monitors were provided. Blood transfusions were free of charge, from the local blood transfusion services, prescreened for standard transfusion transmissible infections 16 (but not for malaria) and prepared using standard procedures, but did not include leucocyte reduction. 22 Other than the transfusion randomisation, all children received standard treatments following national guidelines, 23,24 including anthelmintics.…”

“…15 We have previously described the blood packs used in the trial. 16 At the same time, children in both strata were randomly assigned using a factorial design to receive 3 months of co-trimoxazole prophylaxis or not, and to 3 months of multivitamin multimineral supplement supplementation (containing 10 mg iron as microencapsulated ferrous folate and 150 µg folic acid daily for all ages) versus 3 months of standard treatment with iron (either 25 mg iron for children <2 years or 60 mg iron for children ≥2 years) and folate (100-400 µg, depending on the local formulation used as standard-of-care at sites). The multivitamin multimineral supplement also contained vitamins A, B1 (thiamine), B2 (riboflavin), B3 (niacin), B6, B12, C, D, zinc, copper, selenium, and iodine, in addition to folic acid and iron (doses, recommended nutrient intake [RNI] for iron, 17 and is included in the appendix (p 4); provided by Hexagon Nutrition (Exports) Private, Chenai, India).…”

“…There was also no evidence of difference between co-trimoxazole versus no co-trimoxazole in the development of severe anaemia after discharge (p=0•87, table 3), or in the proportions of children achieving correction of anaemia (>9 g/dL; figure 3) after discharge (p>0•3), or in the mean change in haemoglobin from baseline (p>0•4; appendix p 17). Overall, 2871 (74%) children had already achieved a haemoglobin concentration of at least 6 g/dL by 48 h and 665 (17%) children had achieved a concentration of more than 9 g/dL (figure 3; appendix pp [16][17]38). Discharge haemoglobin concentrations were not available, but by 28 days after discharge, they had increased to 3352 (92%) and 2100 (58%), respectively, and subsequently remained fairly stable.…”

Point‐of‐care haemoglobin testing in African hospitals: a neglected essential diagnostic test

“…Nevertheless, the comparison does not fully address whether ward‐based tests, which in many hospitals include results from a haematocrit machine, may be less accurate than a haematocrit from a haemogram. In order for us to examine this specific question, we compared haemoglobin measured by HemoCue to estimated haemoglobin calculated from haematocrit (from a ward‐based machine) taken from bags of donor whole blood used in the TRACT trial ( n = 2 220 packs) 29 . The mean difference between the two methods was −0·82 ( P < 0·0001, one‐sample two‐sided t ‐test; Fig 3) Lin’s concordance coefficient was 0·72 (95% CI 0·70–0·73).…”