Packed red cells versus whole blood transfusion for severe paediatric anaemia, pregnancy‐related anaemia and obstetric bleeding: an analysis of clinical practice guidelines from sub‐Saharan Africa and evidence underpinning recommendations

Abstract

Objective Blood component transfusion is increasingly promoted in sub‐Saharan Africa (SSA), but is resource‐intensive so whole blood is often used. We examined SSA recommendations about whole blood and packed red cell transfusions for pregnancy‐related bleeding or anaemia, and paediatric anaemia, and evaluated the evidence underpinning these recommendations. Method Relevant SSA guidelines were identified using five electronic databases, websites for SSA Ministries of Health, blood transfusion services and WHO. To facilitate comparisons, indications for transfusing packed red cells or whole blood within these guidelines and reasons given for these recommendations were recorded on a pre‐designed matrix. The AGREE II tool was used to appraise guidelines that gave a reason for recommending either packed red cells or whole blood. We systematically searched MEDLINE, CINAHL, Global Health, Cochrane library and NHSBT Transfusion Evidence Library, using PRISMA guidelines, for clinical studies comparing whole blood with packed red cells or combined blood components in obstetric bleeding or anaemia, or paediatric anaemia. Characteristics and findings of included studies were extracted in a standardised format and narratively summarised. Results 32 English language guidelines from 15 SSA countries mentioned packed red cell or whole blood use for our conditions of interest. Only seven guidelines justified their recommendation for using packed red cells or whole blood. No recommendations or justifications had supporting citations to research evidence. 33 full‐text papers, from 11 234 citations, were reviewed but only one study met our inclusion criteria. This was a single‐centre study in post‐partum haemorrhage. Conclusion Evidence comparing whole blood and packed red cell transfusion for common paediatric and maternal indications is virtually absent in SSA. Therefore, it is unclear whether policies promoting red cells over whole blood transfusion are clinically appropriate. Building a relevant evidence base will help develop effective policies promoting the most appropriate use of blood in African settings.

Assessment of recipients’ characteristics, transfusion appropriateness, and utilization pattern of blood and blood products in Jimma Medical Center, Jimma, Ethiopia

“…Although blood component preparation and use have been increasingly advocated for sub-Saharan Africa countries, whole blood was found to be used as a sole component for transfusion, as the former is a resource-demanding practice [65]. The majority of patients (97%) in this study received whole blood contrary to the rare or no use of this component for transfusion in recent medical practices [38,65]. Anemic individuals can be treated effectively by transfusing concentrated red cells, as this product contains minimal plasma content [60].…”

Is fresh, leucodepleted, whole blood transfusion superior to blood component transfusion in pediatric patients undergoing spinal deformity surgeries? A prospective, randomized study analyzing postoperative serological parameters and clinical recovery

“…Such an approach has rekindled interest in the administration of FWB to trauma patients with hypovolemia [5]. Subsequently, studies have also analyzed the roles of FWB and BC in patients undergoing cardiovascular, obstetric and oncological surgeries [5,15,18,19,[19][20][21]. Spinal surgery is a rapidly growing specialty, with a humongous 220% rise in volume of procedures over the past 15 years [1,3,4].…”

“…Another potential advantage of FWB transfer over CT is the relatively lower possibility of coagulopathy and postoperative BL. Studies have shown significant hemostatic benefits of FWB administration in diverse clinical situations including trauma-induced coagulopathy [9], pediatric cardiovascular procedures [19] and obstetric BL [21]. A recent study published in 2020 has discussed the distinct advantages of modified WB [cold-stored low-titer anti-A and anti-B group O whole blood (LTOWB)] in civilian trauma situations including a 53% reduction in need for transfusion and twofold improvement in 28-day survival, as compared with CT [10].…”

Blood use in sub‐Saharan Africa: a systematic review of current data

“…Possible explanations for these findings, especially the high percentage of WB use in SSA, could be factors associated with limited clinical awareness and the high cost of component separation, as well as the local blood demand for WB. Whereas the latter aligns with the World Health Organization's (WHO) recommendation for blood product use, in general policies and practices related to component use in SSA remain unclear . However, lower FFP and PLT use in SSA may be related to the high‐cost investment required to prepare and store these components.…”