Adherence to clinical guidelines for use of blood components at a tertiary hospital in Ghana

Background and objectives

Guidelines for blood transfusions can help to ensure that blood is used appropriately, to avoid wastage and minimize risks, and are particularly important in sub‐Saharan Africa because chronic blood shortages are widespread. This study explored transfusion practices and guideline compliance among clinicians at a tertiary hospital in the Volta region of Ghana.

Materials and methods

Participants in this 3‐month study were clinicians from several hospital departments. The mixed methods study used a questionnaire to assess clinicians’ knowledge of transfusion. Retrospective data from hospital records were used to assess whether each transfusion given during the study period complied with recommendations in the national transfusion guidelines.

Results

Although 44/50 clinicians self‐rated their knowledge of transfusion in the questionnaire as good, only two were aware of the national transfusion guidelines, 48% listed incorrect indications for fresh frozen plasma (FFP) and there was considerable variation in haemoglobin thresholds they used to guide transfusion decisions. Of the 313 transfusions of whole blood/packed cells and FFP given during the study, 49% were not in accordance with the guidelines. For the 31 FFP transfusions, under‐dosing was common (87%) and 52% were not in accordance with the guidelines. 46/220 (21%) patients had no cause for anaemia documented during their admission.

Conclusion

There is a need to improve awareness of, and compliance with, national guidelines. A multi‐faceted approach including education, guideline dissemination, transfusion audits and oversight from a hospital transfusion committee could contribute to much more effective use of blood components.