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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.


Timing of deaths occurring in children prescribed blood transfusion.
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fig3: Timing of deaths occurring in children prescribed blood transfusion.

Mentions: Seven percent (3,486/53,174) of admissions in the 10 hospitals died, and 13% (381/2,875) of these deaths occurred in children for whom a transfusion was ordered. Among the patients with blood transfusion prescribed (N = 2,875), the group which was not transfused witnessed the highest mortality of 20% (105/523) compared with 12% (276/2,352) among those transfused. Most deaths of children for whom blood was ordered but not given occurred on the admission day and the following day (N = 46 and 34, respectively, Figure 3Figure 3.


Blood Transfusion Delay and Outcome in County Hospitals in Kenya
Timing of deaths occurring in children prescribed blood transfusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Timing of deaths occurring in children prescribed blood transfusion.
Mentions: Seven percent (3,486/53,174) of admissions in the 10 hospitals died, and 13% (381/2,875) of these deaths occurred in children for whom a transfusion was ordered. Among the patients with blood transfusion prescribed (N = 2,875), the group which was not transfused witnessed the highest mortality of 20% (105/523) compared with 12% (276/2,352) among those transfused. Most deaths of children for whom blood was ordered but not given occurred on the admission day and the following day (N = 46 and 34, respectively, Figure 3Figure 3.

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 < 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.