Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Trop Med Int Health. 2019 Jan;24(1):11-22. doi: 10.1111/tmi.13173. Epub 2018 Nov 22.
Blood component transfusion is increasingly promoted in sub-Saharan Africa (SSA), but is resource-intensive so whole blood is often used. We examined SSA recommendations about whole blood and packed red cell transfusions for pregnancy-related bleeding or anaemia, and paediatric anaemia, and evaluated the evidence underpinning these recommendations.
Relevant SSA guidelines were identified using five electronic databases, websites for SSA Ministries of Health, blood transfusion services and WHO. To facilitate comparisons, indications for transfusing packed red cells or whole blood within these guidelines and reasons given for these recommendations were recorded on a pre-designed matrix. The AGREE II tool was used to appraise guidelines that gave a reason for recommending either packed red cells or whole blood. We systematically searched MEDLINE, CINAHL, Global Health, Cochrane library and NHSBT Transfusion Evidence Library, using PRISMA guidelines, for clinical studies comparing whole blood with packed red cells or combined blood components in obstetric bleeding or anaemia, or paediatric anaemia. Characteristics and findings of included studies were extracted in a standardised format and narratively summarised.
32 English language guidelines from 15 SSA countries mentioned packed red cell or whole blood use for our conditions of interest. Only seven guidelines justified their recommendation for using packed red cells or whole blood. No recommendations or justifications had supporting citations to research evidence. 33 full-text papers, from 11 234 citations, were reviewed but only one study met our inclusion criteria. This was a single-centre study in post-partum haemorrhage.
Evidence comparing whole blood and packed red cell transfusion for common paediatric and maternal indications is virtually absent in SSA. Therefore, it is unclear whether policies promoting red cells over whole blood transfusion are clinically appropriate. Building a relevant evidence base will help develop effective policies promoting the most appropriate use of blood in African settings.
在撒哈拉以南非洲（SSA），血液成分输血越来越受到推崇，但这种方法资源密集，因此经常使用全血。我们研究了 SSA 关于妊娠相关出血或贫血、儿科贫血时输注全血和浓缩红细胞的建议，并评估了这些建议的证据基础。
使用五个电子数据库、SSA 卫生部、输血服务机构和世卫组织的网站，确定相关的 SSA 指南。为了便于比较，我们在预先设计的矩阵中记录了这些指南中输注浓缩红细胞或全血的指征以及推荐这些建议的原因。使用 AGREE II 工具评估了为推荐输注浓缩红细胞或全血提供了理由的指南。我们根据 PRISMA 指南，系统地检索了 MEDLINE、CINAHL、全球卫生、考科蓝图书馆和英国国家医疗服务体系血液与移植证据库，以查找比较全血与浓缩红细胞或组合血液成分在产科出血或贫血或儿科贫血中应用的临床研究。以标准化格式提取纳入研究的特征和结果，并进行叙述性总结。
来自 15 个 SSA 国家的 32 份英文指南提到了我们关注的条件下使用浓缩红细胞或全血。只有 7 份指南为其推荐使用浓缩红细胞或全血提供了依据。没有建议或依据引用了研究证据。从 11234 条引文中，共审查了 33 篇全文论文，但只有一项研究符合我们的纳入标准。这是一项关于产后出血的单中心研究。
在 SSA，比较全血和浓缩红细胞输血治疗常见儿科和孕产妇指征的证据几乎不存在。因此，不清楚是否有政策提倡用红细胞替代全血输血在临床上是否合适。建立一个相关的证据基础将有助于制定在非洲环境中促进最适当使用血液的有效政策。
