Development and evaluation of a new paediatric blood transfusion protocol for Africa.

Severe anaemia is a common childhood emergency in developing countries. Practical evidence-based guidance on when to transfuse, volume of transfusion and ideal duration of transfusion is lacking. The aim of this study is to develop a paediatric transfusion protocol for use in under-resourced environments and evaluate its usability in a busy African hospital setting. A paediatric transfusion protocol based on the WHO Guidelines was developed for the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. On the basis of simple bedside clinical features of respiratory, cardiovascular and neurological compromise, the protocol allocates children with severe anaemia (haemoglobin <or= 6 g dL(-1)) to one of the three groups: complicated anaemia, uncomplicated anaemia and anaemia with severe malnutrition. Data were collected to monitor protocol adherence, delays to transfusion, post-transfusion haemoglobin and need for repeat transfusion. Two-hundred and fifteen severely anaemic children were enrolled: 180 complicated, 25 uncomplicated and 10 severely malnourished. With respect to protocol adherence, all children were allocated to the correct transfusion group; correct volume (+/-10%) was given in 89.3%; correct duration (+/-30 min) in 86.2% and correct overall rate (+/-10%) in 78.6%. Comparing old and new transfusion guidelines, a potential avoidable transfusion rate of 29% was found. This study demonstrates that clear and detailed transfusion guidelines based on simple bedside clinical features can be used in a very busy children's hospital in sub-Saharan Africa. With minimal additional equipment, volume and duration of transfusion can be well controlled. Furthermore, having a protocol in place results in a significant reduction of avoidable transfusions.