An analysis of blood transfusion practice at the Kenyatta National Hospital Intensive Care Unit

Abstract

Blood transfusion in the critically ill is a subject that has been under focus in many parts of the world in order to establish safe and proper transfusion practices. This study was thus undertaken so as to determine the transfusion practices at the Kenyatta National Hospital Intensive Care Unit, and in so doing, to be able to highlight some recommendations on safe transfusion practice. The study design was a prospective, observational, descriptive study. It was carried out from December 2007 to March 2008. A total of 64 patients were analysed, among them 40 males and 24 females, as long as they required transfusion at some point while at the ICU. The patients* ages ranged from 1 to 90 years with a mean of 33.39 years. Among these. 10 were children aged 12 years and below. The study established a blood transfusion rate of 21.26%. out of the total number of ICU inpatient admissions that were 301 during the study period. The commonest indication for transfusion was anaemia without any signs of active bleeding with 22 males (55%). and 13 females (54.2%). In the patients assessed, seventeen (42.5%) of the males were being given a haematinic. while for the females, six (25%) of them received a haematinic during the study period. The respiratory and the neurological systems were the most common primary admission categories (36 and 35 patients, i.e. 56.25% and 54.7%) respectively, while most of the admission types were emergency with 45 patients (70.3%). Twenty nine patients (45.3%) were transfused one unit of whole blood, while twenty five (39.1%) received two units of whole blood. Out of all the patients transfused, seven (10.9%) got a transfusion reaction, with the majority-, five patients (7.8%) being a transient febrile reaction. The mean haemoglobin level at admission wras 9.97grams/decilitre for all the patients. The mean pre-transfusion haemoglobin level was 7.08grams/decilitre with a minimum of 3.0 and a maximum of 10.0 grams/decilitre. while the mean post-transfusion haemoglobin level was 9.72 grams/decilitre. with a minimum of 5.90 and a maximum of 14.90 grams/decilitre. The mean duration of stay in the critical care unit before the patients got their first transfusion was 8.23 days. Statistical analysis revealed a positive correlation between the pretransfusion and the post-transfusion haemoglobin level, with a Spearman Rank Correlation R=0.624: p<0.05 (0.000). There was also a positive correlation between the amount of blood transfused and the presence of a transfusion reaction. [Mann Whitney U test Z=2.033: P<0.05 (0.042)]. Blood transfusion should therefore be used sparingly, bearing in mind the potential risks and poor outcomes in critically ill patients.