Unnecessary blood and blood products transfusion: Single institute study of the expected harmful effect of unneeded transfusion

Abstract

Background. Blood and blood products such as packed RBCs, whole blood or other types of blood transfusions are some of the most common daily medical procedures performed all over the world. However, the doctor decisions to transfuse blood are not easy in clinical practice. Method. It was used a descriptive prospective study including 136 children who received blood and blood products transfusions in Al-Diwanyah Maternity and Children Teaching Hospital, Iraq, from 15 January to 15 November 2023. Result. The gender distribution among patients was of 56 males (41.17%) and 80 females (58.82%), all of them exposed to unnecessary blood transfusion. There was no significant difference in gender between high and low level of the hemoglobin groups. Presence of underlying chronic disease was higher in the group with Hb level less than 8 compared to the group with Hb level above 8 (55.65% vs.44.11 %), and the difference was significant (p = 0.042). Provisional diagnosis before transfusion was more effective in lower hemoglobin level subjects than in those with higher hemoglobin level (p = 0.019). About 70 % of these unneeded transfusions were performed due to lack of doctor awareness regarding the indications and the time when the blood and blood products transfusions were necessary. Conclusion and recommendations. All the new strategies of the hospital should be focused on avoiding the harmful effect of any procedure like blood transfusions, weighting their balance of benefits and harms. It is no need to perform a blood transfusion as an initial treatment if the affection can be treated by other means, excepting the life saving emergency situations after trauma or life threating hemorrhage. In some patients who are asymptomatic and/or where specific therapy is available, lower threshold levels may be acceptable. Continuous medical educational and increased doctor’s knowledge might help decrease unnecessary transfusions. Prior to surgery, multidisciplinary teams and discussions about transfusion should be engaged between pediatrician and surgeon. Safe blood and blood products as well as the cost of blood transfusion services should be considered before any decision.

Keywords

• blood transfusion
• harmful effect