Indications and availability of blood for transfusion in obstetric care at Muhimbili National Hospital, 2016

Abstract

Background: Adequate supply and timely availability of safe blood for transfusion are important components of achieving good quality obstetric care. This is true because obstetric haemorrhage and anaemia are common obstetric complications that cause maternal morbidity and mortality in resource limited countries. Objective: The aim of this study was to determine indications and availability of blood for transfusion in obstetric care at MNH. Methods: This was a cross sectional study conducted at Muhimbili National Hospital (MNH) in Tanzania. Data were collected from records of women admitted for obstetric care and who were in need for blood or blood components transfusion from 1st September 2016 to 30th November 2016. Socio-demographic and clinical data were collected using a questionnaire. Total number of all obstetric admissions in the specified period was used to calculate prevalence of transfusion. Results are presented as median and interquartile range (IQR) for continuous variables and proportions for categorical variables. Results: A total of 2,826 women were admitted at MNH for obstetric care during the study period. Three hundred and sixty three (363) had indications for blood transfusion; half of the indications (183/363) 50.4% were due to obstetric haemorrhage, (149/363) 41% due to chronic anaemia, (14/363) 3.9% due to HELLP syndrome/Coagulopathy, (12/363) 3.3% due to both chronic anaemia & obstetric haemorrhage and (5/363) 1.4% others. Three hundred and fifty one women (351) received blood transfusion, making blood transfusion prevalence of 351/2,826 (12.4%). Of the women prescribed to receive whole blood, (124/265) 47% were transfused with the prescribed amount of whole blood while those prescribed to receive packed red cells, only (5/103) 4.9% received the prescribed packed red cells. Whole blood was the most common transfused (934/1150) 81.2% followed by fresh frozen plasma (FFP) (135/1150) 11.7%, Packed Red Blood Cells (49/1150) 4.3% and platelets concentrates (32/1150) 2.8%. The median time (IQR) from decision to transfuse to actual blood transfusion was 4:05 (7:54) hours.Conclusion: Obstetric haemorrhage and anaemia are still important indications for transfusion in obstetric care and in turn whole blood, FFP and PRBCs are the most common transfused blood types and components. Under half of the patients are transfused with blood units’ amount as prescribed or recommended by the clinicians. The prevailing blood shortage in health facilities results in a long decision to transfusion time interval.