Experience of autologous blood transfusion at a district general hospital in Zambia

Are there simple measures to reduce the risk of HIV infection through blood transfusion in a Zambian district hospital?

OBJECTIVE

To quantify the potential impact of simple measures to reduce the risk of iatrogenic HIV infection through blood transfusion in a Zambian district hospital.

METHODS

Three studies were conducted at St. Francis' Hospital, Katete, Zambia: (1) From 1991 to 1995 HIV seroprevalence among all listed blood donors and the impact of proper subgroup selection were studied retrospectively; (2) the sensitivity of locally used rapid antibody assays (HIV-spot/Wellcozyme HIV 1 & 2) for the detection of HIV in donor blood and the influence of the expiration date of the tests on this sensitivity were determined prospectively from June 1993 until March 1994 by screening all consecutive surgical patients and blood donors; (3) the number of unnecessary blood transfusions was determined retrospectively from January 1995 through January 1996 and prospectively from February 1996 through March 1996, and possibilities to reduce the total number of blood transfusions were considered.

RESULTS

(1) Excluding prisoners, who have an HIV seroprevalence of 19-25%, from the donor population significantly reduces the overall HIV seroprevalence from 13-16% to 8-9% (P < 0. 01). (2) Under local circumstances the sensitivity of the used rapid antibody assays was 6.8-17.9% lower than claimed by the manufacturer. Usage of non-expired tests increased the sensitivity significantly from 88.2% to 91.7% (P < 0.05). (3) None of the 294 studied blood transfusions can be classified as inappropriate according to international standards.

CONCLUSIONS

Simple measures such as proper subgroup selection among blood donors and correct use of non-expired tests may decrease the risk of iatrogenic HIV transmission. Stricter indications for blood transfusions will not substantially reduce the number of transfusions.

An audit to assess the impact of a strategy to reduce inappropriate red cell transfusions at Honiara Hospital

A blood transfusion committee was established at Honiara Central Hospital (HCH), a national referral hospital for the Solomon Islands to promote a rational, safe and cost-effective blood transfusion service and to audit the use of blood particularly in the perioperative context. Following the education strategy, a 29.7% reduction in the number of units of blood crossmatched as a proportion of total admissions was achieved as well as a 30.1% reduction in the number of units transfused per 100 operations. The failure of the education strategy to increase the proportion of 'group and hold' requests confirms the need for an integrated approach between the different hospital departments involved to ensure a fully satisfactory result.