Original Research

Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study

Temitope Adedayo, Don O'Mahony, Oluakyode Adeleke, Sikhumbuzo Mabunda
African Journal of Primary Health Care & Family Medicine | Vol 13, No 1 | a2889 | DOI: https://doi.org/10.4102/phcfm.v13i1.2889 | © 2021 Temitope Adedayo, Don O’Mahony, Olukayode Adeleke, Sikhumbuzo Mabunda | This work is licensed under CC Attribution 4.0
Submitted: 29 December 2020 | Published: 24 June 2021

About the author(s)

Temitope Adedayo, Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
Don O'Mahony, Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
Oluakyode Adeleke, Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
Sikhumbuzo Mabunda, The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia


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Abstract

Background: Unnecessary blood transfusion exposes recipients to potential harms.

Aim: The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion.

Setting: A hospital providing level 1 and 2 services.

Methods: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviews.

Results: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs.

Conclusion: Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines.


Keywords

red blood cell transfusion; doctors’ attitudes; doctors’ practice; transfusion thresholds; overtransfusion; descriptive study; qualitative study

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