Detection of adverse events of transfusion in a teaching hospital in Ghana†

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Blood transfusions are indispensable in sub‐Saharan Africa as they play a key role in the correction of anaemia and the prevention of deaths, especially in pregnant women and children. Blood shortages are unfortunately a frequent occurrence in Africa, with devastating effects (Lund et al., 2013). Severe anaemia results in 1 million deaths each year in children younger than 5 years (Murphy & Breman, 2001), and 26% of maternal haemorrhage deaths in hospital are due to lack of blood (Bates et al., 2008).
Haemovigilance is a set of surveillance procedures covering the whole transfusion chain, from the collection of blood and its components to the follow up of its recipients. The purpose of a haemovigilance system is to increase the safety, efficacy and efficiency of blood transfusion by collecting and assessing information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products and to prevent their occurrence and recurrence (Faber, 2004).
Haemovigilance has been an effective tool for improving transfusion practice since its emergence in the 1990s (de Vries et al., 2011). Findings from the UK haemovigilance system, Serious Hazards of Transfusion (SHOT) programme, triggered changes in transfusion practice to reduce complications such as bacterial infections and transfusion‐related acute lung injury. The SHOT evidence of wrong transfusions and other mistakes resulted in several national initiatives to improve training and safety (Bolton‐Maggs & Cohen, 2013).
Subsequently, many developed countries such as the United States and Canada, and in the European Union, have incorporated haemovigilance programmes into legislation. However, almost all sub‐Saharan African countries do not have an effective haemovigilance system (Tagny et al., 2008). This may be due largely to unavailability of resources and appropriate structures to support such systems. Financial support to maintain such systems when established can also be a challenge. South Africa is one of the few countries in Africa with an ongoing haemovigilance programme, (Faber, 2004), and Namibia has also recently established a haemovigilance programme (Basavaraju et al., 2013).
Reporting of adverse events of transfusion is a component within a haemovigilance system. An adverse event of transfusion occurs when a person receiving blood or a blood component experiences an undesirable and unintended reaction before, during or after the transfusion, which may be related to the administration of the blood or component (Garozzo et al., 2010). Besides seeking to recruit donors to increase blood supply, judicious use of available blood and putting in place measures to reduce wastage, such as avoiding unnecessary termination of transfusions or preventing adverse events of transfusion, will ultimately make more effective use of the scarce blood resources.
In Africa, there are generally limited data on adverse events of transfusion and haemovigilance. Compared with more wealthy countries, there are only a few studies from Africa that have investigated adverse events of transfusion, and the reported incidence of these events has been varied. In a prospective review of patient records in a Cameroonian hospital performed in 2001, more than 50% of transfusions were associated with unfavourable outcomes. These reactions were predominantly febrile or urticarial reactions (Mbanya et al., 2001). A study in 2013 from Zimbabwe determined the incidence of transfusion reactions to be 0·46 per 1000 blood components (Mafirakureva et al., 2014), and a recent study in Namibia showed significant under‐reporting of transfusion reactions (Meza et al., 2014).
This aim of our study was to establish the incidence and types of adverse events of transfusions in Kumasi, Ghana in order to identify events for which interventions can be quickly put in place to reduce adverse events and make blood transfusions safer.
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