Original article

Blood Transfusion - 4 2022 (July-August)

Characterising differences in red blood cell usage patterns between healthcare sectors in South Africa: 2014-2019

Authors

Key words: healthcare sectors, public health policy, transfusion prescribing practices, pre-transfusion haemoglobin, patient blood management
Publication Date: 2021-11-29

Abstract

Background - South Africa aims to transition from a two-tiered healthcare system (public and private) to universal health coverage. Data on red blood cell (RBC) product usage reveal disparities between the sectors. Blood transfusion services further need to understand differing disease profiles and transfusion prescribing practices between the sectors to ensure blood security should the transition to a two-tiered health system come to fruition.
Materials and methods - Operational data for public and private healthcare RBC requests between 1 January 2014 and 31 March 2019, obtained from the South African National Blood Service (SANBS), were retrospectively analysed. Sector-specific demographic and utilisation trends were compared for the dominant clinical disciplines. Pre-transfusion haemoglobin (Hb) patterns were also delineated for 2018.
Results - Between 2014 and 2019, 2,356,411 public and private sector RBC transfusion events resulted in the issue of 4,020,094 RBC units (1,553,159 transfusion events and 2,495,054 units within the public sector versus 803,282 transfusion events and 1,525,040 units in private). The dominant clinical disciplines within the public sector were Medical (32.9%), Gynaecology/Obstetrics (27.3%), General Surgery (13.6%), and Paediatrics (including Paediatric Surgery) (6.5%), compared to Intensive Care Units (33.2%), Medical (28.3%), General Surgery (10.4%), and Haematology/Oncology (8.3%) in the private sector. Median pre-transfusion Hb values for 2018 were lower in the public than in the private sector: 6.9 g/dL public sector versus 8 g/dL private sector.
Discussion - Clinical drivers of RBC usage within the public and private healthcare sectors in South Africa differ significantly. Disparate pre-transfusion Hb between the sectors are likely due to differing disease profiles and severity, as well as differences in practice in prescribing transfusions. Implementation of a nationally co-ordinated Patient Blood Management programme may help to address these disparities and help ensure a sustainable blood transfusion system

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Authors

Larisse Bolton - South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa

Karin van den Berg - Translational Research, Medical Division, South African National Blood Service, Roodepoort, South Africa; Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa

Ronél Swanevelder - Translational Research, Medical Division, South African National Blood Service, Roodepoort, South Africa

Juliet R.C. Pulliam - South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa

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