Abstract

ADEDAYO, Temitope; O'MAHONY, Don; ADELEKE, Olukayode  and  MABUNDA, Sikhumbuzo. Doctors' practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study. Afr. j. prim. health care fam. med. (Online) [online]. 2021, vol.13, n.1, pp.1-8. ISSN 2071-2936.  http://dx.doi.org/10.4102/phcfm.v13i1.2889.

BACKGROUND: Unnecessary blood transfusion exposes recipients to potential harmsAIM: The aim of this study was to describe blood transfusion practice and explore doctors' attitudes towards transfusionSETTING: A hospital providing level 1 and 2 servicesMETHODS: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviewsRESULTS: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costsCONCLUSION: Most orders were for two or more units. In medical anaemia, doctors' compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines

Keywords : red blood cell transfusion; doctors' attitudes; doctors' practice; transfusion thresholds; overtransfusion; descriptive study; qualitative study.

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