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First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented?
Anaemia is a significant public health concern in South Africa, oJen inadequately inves4gated and inappropriately treated with blood transfusions. In the context of chronic blood shortages and a high burden of micronutrient deficiencies, appropriate anaemia workups and implementa4on of pa4ent blood...
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| Format: | Thesis |
| Language: | English English |
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Department of Medicine
2026
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| _version_ | 1869483665960992768 |
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| access_status_str | Open Access |
| author | Coetzee, Andrea |
| author2 | Louw, Vernon |
| author_browse | Coetzee, Andrea Louw, Vernon |
| author_facet | Louw, Vernon Coetzee, Andrea |
| author_sort | Coetzee, Andrea |
| collection | Thesis |
| description | Anaemia is a significant public health concern in South Africa, oJen inadequately inves4gated and inappropriately treated with blood transfusions. In the context of chronic blood shortages and a high burden of micronutrient deficiencies, appropriate anaemia workups and implementa4on of pa4ent blood management (PBM) principles are essen4al. PBM aims to improve pa4ent outcomes by op4mising anaemia management and reducing unnecessary red blood cell transfusions. This study evaluated the implementa4on of PBM principles in the emergency department at Groote Schuur Hospital, a large academic ins4tu4on, by assessing laboratory tes4ng for micronutrient deficiencies and blood ordering prac4ces in pa4ents receiving a first-4me red blood cell transfusion. This retrospec4ve cross-sec4onal study reviewed the medical records of a consecu4ve sample of adult pa4ents who received first-4me transfusions in the medical emergency unit between April and October 2023. Data were collected from the Western Cape Blood Service, Na4onal Health Laboratory Service, and pa4ent records, including demographic details, transfusion characteris4cs, anaemia workups, and iron supplementa4on. Laboratory inves4ga4ons for iron, vitamin B12, and folate deficiencies were analysed and further stra4fied by pre- transfusion mean corpuscular volume to assess minimally acceptable tests performed per group. Pa4ent subgroups were compared, and iron deficiency was evaluated using three serum ferri4n-based defini4ons. Transfusion indica4ons were compared between blood request forms and clinical notes. Of 198 pa4ents, 29% received a full laboratory workup for micronutrient deficiencies (serum ferri4n, transferrin satura4on, vitamin B12, and serum folate), 32% had par4al tes4ng, and 39% had no haema4nic inves4ga4ons performed. A minimally acceptable workup, based on common micronutrient deficiencies per mean corpuscular volume range, was performed in 63% of pa4ents with microcy4c anaemia (serum ferri4n), 73% with macrocy4c anaemia (serum folate and vitamin B12), and 31% with normocy4c anaemia (serum ferri4n, vitamin B12 and folate). Iron deficiency was the most common finding (26%), with low rates of folate (1%) and vitamin B12 (2%) deficiencies among those tested. Up to 30% of pa4ents with iron deficiency had normocy4c anaemia, depending on the cut-off value used. Among iron- deficient pa4ents, 76% received iron supplementa4on. However, some pa4ents received supplementa4on despite not mee4ng any criteria for iron deficiency, including 13 pa4ents in the group with high serum ferri4n values. There were 17 pa4ents who received iron without serum ferri4n tes4ng. Most transfusion episodes (62%) involved mul4ple red blood cell units. Of these, 67% had no documenta4on of ac4ve bleeding, and 82% had no evidence of life-threatening haemorrhage. The median pre-transfusion haemoglobin was 6.0 g/dL. We observed high rates of gastrointes4nal bleeding (24%) and anaemia of inflamma4on (23%). These findings reveal significant deficiencies in the applica4on of PBM principles in the emergency department, including the frequent omission of appropriate anaemia inves4ga4ons prior to transfusion. Iron supplementa4on rates were high in iron-deficient pa4ents but were also prescribed in those with no evidence of deficiency or iron tes4ng. While a restric4ve transfusion strategy was followed in most circumstances, mul4-unit transfusions iv oJen occurred without a clear indica4on. These findings support the need for con4nued educa4on, regular audit, and feedback to promote ra4onal use of blood transfusion and improve anaemia care and pa4ent outcomes in emergency sebngs. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/43381 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-07-01T04:02:37.168Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/43381 First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented? Coetzee, Andrea Louw, Vernon Kropman, Annemarie public health South Africa Anaemia is a significant public health concern in South Africa, oJen inadequately inves4gated and inappropriately treated with blood transfusions. In the context of chronic blood shortages and a high burden of micronutrient deficiencies, appropriate anaemia workups and implementa4on of pa4ent blood management (PBM) principles are essen4al. PBM aims to improve pa4ent outcomes by op4mising anaemia management and reducing unnecessary red blood cell transfusions. This study evaluated the implementa4on of PBM principles in the emergency department at Groote Schuur Hospital, a large academic ins4tu4on, by assessing laboratory tes4ng for micronutrient deficiencies and blood ordering prac4ces in pa4ents receiving a first-4me red blood cell transfusion. This retrospec4ve cross-sec4onal study reviewed the medical records of a consecu4ve sample of adult pa4ents who received first-4me transfusions in the medical emergency unit between April and October 2023. Data were collected from the Western Cape Blood Service, Na4onal Health Laboratory Service, and pa4ent records, including demographic details, transfusion characteris4cs, anaemia workups, and iron supplementa4on. Laboratory inves4ga4ons for iron, vitamin B12, and folate deficiencies were analysed and further stra4fied by pre- transfusion mean corpuscular volume to assess minimally acceptable tests performed per group. Pa4ent subgroups were compared, and iron deficiency was evaluated using three serum ferri4n-based defini4ons. Transfusion indica4ons were compared between blood request forms and clinical notes. Of 198 pa4ents, 29% received a full laboratory workup for micronutrient deficiencies (serum ferri4n, transferrin satura4on, vitamin B12, and serum folate), 32% had par4al tes4ng, and 39% had no haema4nic inves4ga4ons performed. A minimally acceptable workup, based on common micronutrient deficiencies per mean corpuscular volume range, was performed in 63% of pa4ents with microcy4c anaemia (serum ferri4n), 73% with macrocy4c anaemia (serum folate and vitamin B12), and 31% with normocy4c anaemia (serum ferri4n, vitamin B12 and folate). Iron deficiency was the most common finding (26%), with low rates of folate (1%) and vitamin B12 (2%) deficiencies among those tested. Up to 30% of pa4ents with iron deficiency had normocy4c anaemia, depending on the cut-off value used. Among iron- deficient pa4ents, 76% received iron supplementa4on. However, some pa4ents received supplementa4on despite not mee4ng any criteria for iron deficiency, including 13 pa4ents in the group with high serum ferri4n values. There were 17 pa4ents who received iron without serum ferri4n tes4ng. Most transfusion episodes (62%) involved mul4ple red blood cell units. Of these, 67% had no documenta4on of ac4ve bleeding, and 82% had no evidence of life-threatening haemorrhage. The median pre-transfusion haemoglobin was 6.0 g/dL. We observed high rates of gastrointes4nal bleeding (24%) and anaemia of inflamma4on (23%). These findings reveal significant deficiencies in the applica4on of PBM principles in the emergency department, including the frequent omission of appropriate anaemia inves4ga4ons prior to transfusion. Iron supplementa4on rates were high in iron-deficient pa4ents but were also prescribed in those with no evidence of deficiency or iron tes4ng. While a restric4ve transfusion strategy was followed in most circumstances, mul4-unit transfusions iv oJen occurred without a clear indica4on. These findings support the need for con4nued educa4on, regular audit, and feedback to promote ra4onal use of blood transfusion and improve anaemia care and pa4ent outcomes in emergency sebngs. 2026-06-25T09:29:22Z 2026-06-25T09:29:22Z 2026 2026-06-25T09:04:47Z Thesis / Dissertation Masters MSc http://hdl.handle.net/11427/43381 en eng application/pdf Department of Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | public health South Africa Coetzee, Andrea First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented? |
| thesis_degree_str | Master's |
| title | First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented? |
| title_full | First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented? |
| title_fullStr | First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented? |
| title_full_unstemmed | First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented? |
| title_short | First-time red blood cell transfusions in the emergency department: are patient blood management principles implemented? |
| title_sort | first time red blood cell transfusions in the emergency department are patient blood management principles implemented |
| topic | public health South Africa |
| url | http://hdl.handle.net/11427/43381 |
| work_keys_str_mv | AT coetzeeandrea firsttimeredbloodcelltransfusionsintheemergencydepartmentarepatientbloodmanagementprinciplesimplemented |