Blood and Blood Components Transfusion Practices in the Newborn Unit, Kenyatta National Hospital

Abstract

Introduction: Blood transfusion is a commonly used supportive therapy in neonatal units worldwide. There are significant differences in blood transfusion practices among countries, newborn units and clinicians. Data on blood transfusion practices in neonatal units in Kenya is scarce. Objective: To determine the prevalence of transfusion, pretransfusion haematological parameters, and transfusion practices of blood and various blood components in the Newborn Unit (NBU) of Kenyatta National Hospital (KNH). Methods: A descriptive cross-sectional study. Medical records of 330 neonates admitted over a 3-months’ period were reviewed. A survey was then conducted among 19 clinicians in the NBU. Data analysis: Statistical Package for Social Sciences (SPSS) version 21.0 was used for data analysis. Nominal data was summarized using counts and percentages and continuous variable using measures of central tendency and dispersion. Data was presented using tables, pie charts and bar graphs. Results: The prevalence of blood transfusion was 10.9%. The most commonly used blood component was packed red blood cells (PRBC) accounting for 66.7% of all transfusions, followed by platelets, 27.8%, while fresh frozen plasma (FFP) accounted for only 5.5% of transfusions. The mean pre-transfusion Hb was 10.8g/dl, and was highest in neonates who were on O2 via nasal prongs (13.4g/dl) and those who were transfused in the 2nd postnatal week (11.3g/dl). The median pre-transfusion platelet count was 14 x109/l. All neonates who received FFP had deranged coagulation profile and active bleeding. There was a wide variation in Hb thresholds for PRBC transfusion among clinicians and suboptimal monitoring of neonates during blood transfusion. Conclusion: The current PRBC prescribing patterns and the overall monitoring of neonates on blood components transfusion in the KNH NBU are suboptimal and do not align with the current available evidence. Implementation of quality improvement activities to address the identified gaps is recommended.