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Blood Transfusion Delay and Outcome in County Hospitals in Kenya

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ABSTRACT

Severe anemia is a leading indication for blood transfusion and a major cause of hospital admission and mortality in African children. Failure to initiate blood transfusion rapidly enough contributes to anemia deaths in sub-Saharan Africa. This article examines delays in accessing blood and outcomes in transfused children in Kenyan hospitals. Children admitted with nonsurgical conditions in 10 Kenyan county hospitals participating in the Clinical Information Network who had blood transfusion ordered from September 2013 to March 2016 were studied. The delay in blood transfusion was calculated from the date when blood transfusion was prescribed to date of actual transfusion. Five percent (2,875/53,174) of admissions had blood transfusion ordered. Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin < 5 g/dl and 36% (2,232/6,198) of all children admitted with a diagnosis of anemia were reported to have hemoglobin < 5 g/dL. Of all the ordered transfusions, 82% were administered and documented in clinical records, and three-quarters of these (75%, 1,760/2,352) were given on the same day as ordered but these proportions varied from 71% to 100% across the 10 hospitals. Children who had a transfusion ordered but did not receive the prescribed transfusion had a mortality of 20%, compared with 12% among those transfused. Malaria-associated anemia remains the leading indication for blood transfusion in acute childhood illness admissions. Delays in transfusion are common and associated with poor outcomes. Variance in delay across hospitals may be a useful indicator of health system performance.

No MeSH data available.


Time between prescription and transfusion from the day of admission for all children who had blood prescribed in 10 Clinical Information Network hospitals.
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fig1: Time between prescription and transfusion from the day of admission for all children who had blood prescribed in 10 Clinical Information Network hospitals.

Mentions: Five percent (2,875/53,174) of admissions had blood transfusion ordered. In most cases, the diagnoses associated with the order for blood transfusion were anemia 78% (2,240/2,875) and malaria 73% (2,094/2,875) (Table 1). Less than 10% of the children for whom blood transfusion was ordered had severe acute malnutrition (8%, 226/2,875) or both malaria and sickle cell disease (5%, 149/2,875). Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin < 5 g/dL and 36% (2,232/6,198) of all children admitted with a diagnosis of anemia were reported to have hemoglobin < 5 g/dL. Of all the ordered transfusions, 82% (2,352/2,875) were documented to have been given, and three-quarters of these (75%, 1,760/2,352) were given on the day they were ordered (Figure 1Figure 1.


Blood Transfusion Delay and Outcome in County Hospitals in Kenya
Time between prescription and transfusion from the day of admission for all children who had blood prescribed in 10 Clinical Information Network hospitals.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5303061&req=5

fig1: Time between prescription and transfusion from the day of admission for all children who had blood prescribed in 10 Clinical Information Network hospitals.
Mentions: Five percent (2,875/53,174) of admissions had blood transfusion ordered. In most cases, the diagnoses associated with the order for blood transfusion were anemia 78% (2,240/2,875) and malaria 73% (2,094/2,875) (Table 1). Less than 10% of the children for whom blood transfusion was ordered had severe acute malnutrition (8%, 226/2,875) or both malaria and sickle cell disease (5%, 149/2,875). Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin < 5 g/dL and 36% (2,232/6,198) of all children admitted with a diagnosis of anemia were reported to have hemoglobin < 5 g/dL. Of all the ordered transfusions, 82% (2,352/2,875) were documented to have been given, and three-quarters of these (75%, 1,760/2,352) were given on the day they were ordered (Figure 1Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Severe anemia is a leading indication for blood transfusion and a major cause of hospital admission and mortality in African children. Failure to initiate blood transfusion rapidly enough contributes to anemia deaths in sub-Saharan Africa. This article examines delays in accessing blood and outcomes in transfused children in Kenyan hospitals. Children admitted with nonsurgical conditions in 10 Kenyan county hospitals participating in the Clinical Information Network who had blood transfusion ordered from September 2013 to March 2016 were studied. The delay in blood transfusion was calculated from the date when blood transfusion was prescribed to date of actual transfusion. Five percent (2,875/53,174) of admissions had blood transfusion ordered. Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin &lt; 5 g/dl and 36% (2,232/6,198) of all children admitted with a diagnosis of anemia were reported to have hemoglobin &lt; 5 g/dL. Of all the ordered transfusions, 82% were administered and documented in clinical records, and three-quarters of these (75%, 1,760/2,352) were given on the same day as ordered but these proportions varied from 71% to 100% across the 10 hospitals. Children who had a transfusion ordered but did not receive the prescribed transfusion had a mortality of 20%, compared with 12% among those transfused. Malaria-associated anemia remains the leading indication for blood transfusion in acute childhood illness admissions. Delays in transfusion are common and associated with poor outcomes. Variance in delay across hospitals may be a useful indicator of health system performance.

No MeSH data available.