Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study
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 wa...
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| Format: | Article |
| Language: | English |
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AOSIS
2021-06-01
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| Series: | African Journal of Primary Health Care & Family Medicine |
| Subjects: | |
| Online Access: | https://phcfm.org/index.php/phcfm/article/view/2889 |
| _version_ | 1818577587614515200 |
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| author | Temitope Adedayo Don O'Mahony Oluakyode Adeleke Sikhumbuzo Mabunda |
| author_facet | Temitope Adedayo Don O'Mahony Oluakyode Adeleke Sikhumbuzo Mabunda |
| author_sort | Temitope Adedayo |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-16T06:32:17Z |
| format | Article |
| id | doaj.art-a6544a18ff56491e90dc984dcd344f83 |
| institution | Directory Open Access Journal |
| issn | 2071-2928 2071-2936 |
| language | English |
| last_indexed | 2024-12-16T06:32:17Z |
| publishDate | 2021-06-01 |
| publisher | AOSIS |
| record_format | Article |
| series | African Journal of Primary Health Care & Family Medicine |
| spelling | doaj.art-a6544a18ff56491e90dc984dcd344f832022-12-21T22:40:52ZengAOSISAfrican Journal of Primary Health Care & Family Medicine2071-29282071-29362021-06-01131e1e810.4102/phcfm.v13i1.2889837Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods studyTemitope Adedayo0Don O'Mahony1Oluakyode Adeleke2Sikhumbuzo Mabunda3Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, MthathaDepartment of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, MthathaDepartment of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, MthathaThe George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, SydneyBackground: 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.https://phcfm.org/index.php/phcfm/article/view/2889red blood cell transfusiondoctors’ attitudesdoctors’ practicetransfusion thresholdsovertransfusiondescriptive studyqualitative study |
| spellingShingle | Temitope Adedayo Don O'Mahony Oluakyode Adeleke Sikhumbuzo Mabunda Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study African Journal of Primary Health Care & Family Medicine red blood cell transfusion doctors’ attitudes doctors’ practice transfusion thresholds overtransfusion descriptive study qualitative study |
| title | Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study |
| title_full | Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study |
| title_fullStr | Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study |
| title_full_unstemmed | Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study |
| title_short | Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study |
| title_sort | doctors practice and attitudes towards red blood cell transfusion at mthatha regional hospital eastern cape south africa a mixed methods study |
| topic | red blood cell transfusion doctors’ attitudes doctors’ practice transfusion thresholds overtransfusion descriptive study qualitative study |
| url | https://phcfm.org/index.php/phcfm/article/view/2889 |
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