Somy Charuvila, Tasmiah Aziz, Sarah Davidson, Ummay Naznin, Shiuly Sinha, Sabbir Ahmed, Prof Kokila Lakhoo, Prof Tahmina Banu
Paediatric anaemia is highly prevalent in low-middle income countries and can negatively impact postoperative outcomes. Currently, there are no guidelines for the management of paediatric preoperative anaemia. To ensure optimal care in resource limited settings; balancing the risks of anaemia and using resources such as blood transfusion, we first need to understand current practices.
To address this, a joint UK-Bangladesh team conducted a retrospective analysis at a paediatric surgical centre in Bangladesh.
464 patients ≤ 16 years who underwent elective and emergency surgery were categorised into major (351/464), moderate (92/464) and minor (21/464) surgery groups according to anticipated blood loss.
Median age was 4 years and 73% were male. 32.5 % (151/464) patients had preoperative blood testing for anaemia. 17.5 % (81/464) children were transfused pre-operatively. Of those children transfused, 40.7 % (33/81) underwent transfusion solely based on signs of anaemia on clinical examination. 75% of (36/48) children who underwent transfusion after blood testing had haemoglobin ≥ 80g/L. Major surgery category had the highest proportion of children who were transfused and tested for anaemia.
A liberal transfusion approach is evident here. Discussion with local clinicians revealed that this was due to limitations in obtaining timely blood results and to reduce laboratory costs incurred by families when clinical suspicion of anaemia was high. Ongoing research is underway to analyse the potential of bedside haemoglobin testers in conjunction with patient blood management strategies to limit blood transfusions and its associated risks.