Mosha Dominic, Poulsen Anja, Reyburn Hugh, Kituma Elimsaada, Mtei Frank, Bygbjerg Ib C
Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.
BMC Pediatr. 2009 Aug 14;9:51. doi: 10.1186/1471-2431-9-51.
Blood transfusion (BT) can be lifesaving for children; however, monitoring the quality of BT is important. The current study describes the quality of paediatric BT delivered in two district hospitals in north-east Tanzania in order to identify areas for quality assurance and improvement in the administration of BT.
All 166 children admitted in the paediatric wards and receiving BT through April to June 2007 were prospectively observed. Medical records, request forms and registers in the laboratories were reviewed to identify blood source, blood screening and indications for BT. BT was observation before, during and after transfusion process.
Malaria related anaemia accounted for 98% of the BTs. Ninety-two percent of the children were assessed for paleness. Clinical signs such as difficult breathing and symptoms of cardiac failure were only assessed in 67% and 15% of the children respectively, prior to the BT decision. Pre-transfusion haemoglobin and body temperature were recorded in 2/3 of the patients, but respiratory rate and pulse rate were not routinely recorded. In 40% of BTs, the transfusion time exceeded the recommended 4 hours. The zonal blood bank (ZBB) and local donors accounted for 10% and 90% of the blood, respectively. ABO and RhD typing and screening for HIV and syphilis were undertaken in all transfused blood. Evidence for hepatitis B or C infection was not checked except in the ZBB.
Criteria for BT are not always fulfilled; time to initiate and complete the transfusion is often unacceptable long and monitoring of vital signs during BT is poor. Blood from the ZBB was often not available and BT often depended on local donors which implied lack of screening for hepatitis B and C. It is recommended that an external supervision system be established to monitor and evaluate the quality of BT performance in the laboratories as well as in wards.
输血对儿童可能是救命的；然而，监测输血质量很重要。本研究描述了坦桑尼亚东北部两家地区医院的儿科输血质量，以确定输血管理中质量保证和改进的领域。
对2007年4月至6月在儿科病房住院并接受输血的所有166名儿童进行前瞻性观察。审查病历、申请表和实验室登记册，以确定血液来源、血液筛查和输血指征。在输血过程的前、中、后进行观察。
与疟疾相关的贫血占输血病例的98%。92%的儿童接受了面色苍白评估。在做出输血决定之前，分别只有67%和15%的儿童接受了呼吸困难和心力衰竭症状等临床体征评估。三分之二的患者记录了输血前血红蛋白和体温，但呼吸频率和脉搏率未常规记录。在40%的输血中，输血时间超过了推荐的4小时。区域血库（ZBB）和当地献血者分别提供了10%和90%的血液。所有输注的血液都进行了ABO和RhD血型鉴定以及艾滋病毒和梅毒筛查。除了在ZBB外，未检查乙肝或丙肝感染证据。
输血标准并非总是得到满足；开始和完成输血的时间往往长得不可接受，输血期间生命体征监测较差。ZBB的血液往往无法获得，输血常常依赖当地献血者，这意味着缺乏对乙肝和丙肝的筛查。建议建立一个外部监督系统，以监测和评估实验室以及病房输血操作的质量。
