PATTERN, INDICATIONS AND REVIEW OF COMPLICATIONS OF NEONATAL BLOOD TRANSFUSION IN IBADAN, SOUTHWEST NIGERIA

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A.I. Ayede.¹ and T.S. Akingbola.²

1. Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
2. Department of Haematology, University College Hospital, Ibadan, Nigeria.

Abstract

Background and objectives: There is a huge need for blood transfusion in the newborn particularly due to the reduced marrow activity in the neonatal period. Despite widely use of blood products in the neonatal period, there is paucity of local data on the pattern, indications and reactions to blood transfusions in Nigerian newborns. This study evaluates the blood transfusion indications and patterns in special care baby unit and C12nd of University College Hospital, Ibadan, Nigeria.

Methodology: A cross sectional study was carried on the recruited newborns and structured questionnaires were used to obtain bio data, medical problems, indications for blood transfusion, type of blood products transfused and clinical signs. Urinalysis was performed out before and after the transfusion.

Results: A total of 100 neonates were recruited into the study with a male: female ratio of (M: F= 1:1). The age range was 2–34 days and their weight ranged between 0.8kg to 3.6 kg with a mean weight of 1.64 kg. The main indications for transfusion were anaemia from prematurity & neonatal sepsis(NNS) 46%; (red cell replacement), NNS, Disseminated intravascular coagulation(DIC) & anaemia 24%; (partial exchange + top up + Fresh frozen plasma), neonatal jaundice(NNJ) & anaemia 14%; (whole blood), NNJ, NNS + anaemia 6%(Blood transfusion + Fresh frozen plasma), NNS + anaemia 10% (whole blood).

Conclusion: Blood transfusion is still frequent in the study area and prematurity, neonatal sepsis and jaundice rank high in the indications. Transfusion reactions are rare in the evaluated neonates.

Introduction

Blood transfusion is the process of infusion of blood and blood products into an individual’s circulatory system. Blood transfusion is used in a variety of medical conditions to replace lost components of the blood. Component therapy whereby components of the blood such as red cell concentrate, fresh frozen plasma, cryoprecipitate, and platelet concentrate are infused as indicated, has overtaken the old practice of whole blood infusion. The science of blood transfusion dates back to the first decade of the 19th century, with the discovery of distinct blood types leading to the practice of mixing some blood from the donor and the recipient before the transfusion (ref). Blood transfusion need in the neonate is huge because of reduced marrow activity in the neonatal period.¹ Other indications include replacement of losses due to blood loss in the course of taking blood samples for various tests, correction of anaemia, exchange blood transfusion or partial exchange transfusions for removal of bilirubin, removal of antibodies and replacement of red cells. Blood products such as platelets concentrates and fresh frozen plasma can also be transfused in septicaemic neonates with DIC and neonates with bleeding diathesis².In spite of wide use of blood and blood products in the neonatal period, there is paucity of local data on the pattern, indications and reactions to blood transfusions in Nigerian newborns. This study evaluates the blood transfusion indications and patterns in neonates admitted to neonatal wards of University College Hospital, Ibadan, Nigeria.

MATERIALS AND METHODS
Study site
The study was carried out at the Special Care Babyv Unit (SCBU) and C1 2nd wards of the Department of Paediatrics, University College Hospital (UCH) Ibadan, Nigeria. Ibadan is the capital of Oyo state located in the southwest zone of Nigeria. The UCH serves as the referral centre to all primary and secondary health facilities located in Oyo state and even other states in the southwest and other zones. The SCBU admits babies within the first 48 hours of live that are delivered within UCH or referred from outside while C12nd admits both newborns and children up to 1 year of age.

Study Subjects
All the patients involved in this study were neonates admitted either into the SCBU or C12nd of UCH and received blood or blood products transfusion for medically indicated reasons. All the blood and blood products were screened and processed by the Blood Bank of UCH, Ibadan.

Study Type and Methods
The study was a cross sectional study carried out on the recruited newborns in SCBU and C12nd of UCH, between March and October 2010. Structured questionnaires were used to obtain bio data, medical problems, indications for blood transfusion, type of blood products transfused and the frequency, clinical signs before, during and after blood transfusion. Informed consent was obtained from the care givers of the recruited patients. The clinical signs were evaluated by Paediatrics Resident Doctors and a Consultant Paediatrician (AIA) in charge of SCBU. All blood products were prewarmed before transfusion and 1 ml of calcium gluconate was given per every 100 mLs of blood exchanged. Urinalysis was performed on all recruited neonates using multistix urine strip before and 12–24 hours post transfusion. Dual data entry was carried out by using Epi Data version 8 to enable data check, cleaning and verification. All the data were subsequently transferred into Statistical Package for Social Sciences (SPSS) version 17 for analysis. Frequencies were generated for categorical variables and compared using pie and bar charts.