Clinical use of blood and blood components in post-abortion care in Botswana

Abstract

Background: Understanding the pattern and gaps in blood product utilisation in post-abortion care is crucial for evidence-based planning and priority setting. Objective: To describe the current use of blood and blood components in post-abortion care in Botswana. Methods: We conducted a retrospective cross-sectional study across four hospitals in Botswana using routine patients’ records. We included all patients admitted for an abortion between January and August 2014. Descriptive statistics are used to report the results. Results: Whole blood and red cell concentrates were used in 59/619 (9·5%) of patients. Plasma and platelet use was 1·3 and 0·7%, respectively. The mean admission haemoglobin level was 10·07 g dL−1 (SD2·69) and differed significantly between referral and district hospitals. The mean number of blood units transfused per patient was 2·23 (standard deviation (SD) 1·23), with 15/55 (27·3%) receiving a single unit. A total of 43/288 (14·9%) of the patients had haemoglobin levels below7 g dL−1 but did not receive any transfusion. There was a moderate positive correlation between admission haemoglobin level and time to transfusion (Spearman’s rho=0·37, P =0·01). The number of blood units given increased with decreasing admission haemoglobin level. The strength of this association was moderate (Spearman’s rho=−0·48, P <0·001). Conclusion: There is a relatively low utilisation of blood and blood components in post-abortion care in Botswana despite an apparent clinical need in some instances. The reason for this shortfall, as well as its impact on morbidity and mortality, needs to be explored and be a focus of health systems research in Botswana.