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Use of clinical judgement to guide administration of blood transfusions in Malawi

Bates, Imelda ORCID: https://orcid.org/0000-0002-0862-8199, Mundy, Catherine, Pendame, R., Kadewele, G., Gilks, C.F. and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2001) 'Use of clinical judgement to guide administration of blood transfusions in Malawi'. Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol 95, Issue 5, pp. 510-512.

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Abstract

The aim of this study was to investigate whether clinicians in Malawi could use clinical judgement alone to administer blood transfusions in accordance with guidelines. Clinicians at a district hospital did not use the Lovibond Comparator haemoglobin results provided by their laboratory as they felt them to be unreliable, preferring instead to rely on their clinical judgement alone to guide transfusion practice. Their transfusion practice and the Lovibond haemoglobin results were monitored against the World Health Organization recommended haemiglobincyanide method for haemoglobin measurement without the clinicians having access to this result. The Lovibond Comparator method was shown to have a sensitivity of only 21 % to detect trigger haemoglobin values for transfusion published in local guidelines. Without access to a useful haemoglobin result, clinicians gave 67% of transfusions in accordance with the haemoglobin trigger values in the guidelines. This study shows that clinical features alone can provide a reasonable guide about the need for transfusion, and that poor quality laboratory tests limit the effectiveness of transfusion guidelines.

Item Type: Article
Subjects: QY Clinical Pathology > Blood. Blood Chemistry > QY 400 General works
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WB Practice of Medicine > Therapeutics > WB 356 Blood transfusion
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 190 Hemoglobin and other hemeproteins. Porphyrins (Associated with hemoglobin)
Faculty: Department: Pre 2002
Digital Object Identifer (DOI): https://doi.org/10.1016/s0035-9203(01)90022-7
Depositing User: Lynn Roberts-Maloney
Date Deposited: 11 Oct 2013 09:17
Last Modified: 06 Feb 2018 13:05
URI: http://archive.lstmed.ac.uk/id/eprint/3110

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