Transfusion practices in critical care units in Rwanda: A cross-sectional study reviewing best evidence and current practice

Abstract

Background: Blood transfusion is a critical intervention in intensive care units, yet 
adherence to evidence-based guidelines varies globally. In resource-limited 
settings like Rwanda, the balance between transfusion benefits and risks requires 
careful evaluation. This study aimed to assess current transfusion practices, 
guideline adherence, and complications among critically ill patients in Rwandan 
tertiary hospitals. Methods: A prospective observational cross-sectional study was 
conducted from January 2023 to January 2024 across four tertiary hospitals in 
Rwanda. We enrolled 301 adult intensive care unit patients who received blood 
transfusions. Data on patient demographics, transfusion indications, blood 
product types, pre-transfusion laboratory values, guideline adherence, 
complications, and outcomes were collected. Data analysis was conducted in Stata 
version 17. Results: The median age was 36 years (IQR: 27-53), with 51.2% male 
patients. Anemia was the most common transfusion indication (34.6%). The 
median pre-transfusion hemoglobin was 7.5 g/dL (IQR: 6.7-9.2). Packed red blood 
cells were transfused in 85.4% of cases. Rwanda transfusion guidelines were 
followed in 59% of cases, while transfusion reactions occurred in 5.3% of patients. 
Conclusions: Transfusion practices in Rwandan intensive care units showed 
suboptimal adherence to evidence-based guidelines, with significant gaps in 
documentation and protocol implementation. These findings highlight the need 
for improved guideline implementation, enhanced monitoring systems, and 
targeted interventions for high-risk populations in resource-limited critical care 
settings.