Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania.

Autor: Apata IW; Epidemic Intelligence Service.; Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention., Drammeh B; Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention., De AK; Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention., Bjork A; Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention., Pathak S; ICF International, Atlanta, Georgia., Lyimo M; Muhimbili University of Health and Allied Sciences., Juma A; Tanzania National Blood Transfusion., Kutaga R; DGHT, CDC, Dar es Salaam, Tanzania., Mahmoud M; Zanzibar National Blood Transfusion Service, Zanzibar, Tanzania., Nkya E; Tanzania National Blood Transfusion., Kuehnert M; Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention., Marfin A; Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2018 Feb; Vol. 58 (2), pp. 379-389. Date of Electronic Publication: 2018 Jan 19.
DOI: 10.1111/trf.14461
Abstrakt: Background: Resource-limited countries in Africa experience blood shortages. Understanding clinical drivers of blood demand can inform strategies to increase blood availability.
Study Design and Methods: From a national representative sample of 42 hospitals in Tanzania, patient records and requests for whole blood (WB) and red blood cells (RBCs) to treat anemia were analyzed using data collected prospectively from June through September 2013. Abstracted data included cause of anemia, number of requested units, clinical signs, and pretransfusion hemoglobin (Hb) levels. Weighted projections of nationwide drivers of blood demand for the year, 2013, were calculated. Mean posttransfusion Hb levels were estimated, and blood requests were assessed for clinical appropriateness.
Results: Malaria was the leading driver of blood demand for anemia among children, accounting for 67% (55,949 units; standard deviation [SD], 1911 units) of projected units requested for children in 2013. Maternal hemorrhage was the leading driver of blood demand for anemia among adults, accounting for 21% (31,321 units; SD, 963 units) of projected units requested. Seventeen percent (26,133 units; SD, 1013 units) of projected requested units were deemed inappropriate. Adults with severe anemia had a mean Hb level of 3.7 g/dL and a mean of 1.6 WB or RBC units per request, resulting in an estimated mean posttransfusion Hb level of 5.3 g/dL.
Conclusions: Strategies to prevent and treat underlying causes of anemia and decrease inappropriate blood requests will likely increase blood availability. Restrictive blood ordering practices seen in adults with severe anemia suggests undertreatment of anemia and may result in an underestimation of the national blood demand.
(© 2018 AABB.)
Databáze: MEDLINE
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