Assessment of the quality of stored blood for transfusion at Mbarara Regional Referral Hospital, Southwestern Uganda

Abstract

Aim and objective: To assess the quality of blood stored for transfusion at Mbarara Regional Referral Hospital (MRRH) regarding bacterial contamination, malaria infection, and laboratory audit status. Materials and methods: Whole blood and packed red blood cells at MRRH were critically inspected for visual anomalies, and a portion of this blood was aseptically collected and analyzed for Plasmodium species and bacterial contamination using culture methods. For culture positive samples, drug susceptibility testing (DST) was done using the Kirby-Bauer disc diffusion method. An audit using Stepwise Laboratory quality Improvement Process Towards Accreditation (SLIPTA) quality checklist was conducted. The obtained data were analyzed as frequencies and proportions at 95% confidence interval (CI), and significance levels of relatedness were set at p-values<0.05. Results: Of the 202 samples analyzed, 6 (3%) had bacteria while 3 (1.5%) had Plasmodium falciparum trophozoites. The bacterial isolates were Staphylococcus aureus (N=4, 66.7%); Corynebacterium spp (N=1, 16.7%) and Micrococcus spp (N=1, 16.7%). Staphylococcus aureus showed sensitivity to chloramphenicol, oxacillin, amikacin, and gentamycin. Thirty (14.9%) of these units had visually detectable anomalies, and the laboratory audit score was 53.8%. Conclusion: The quality of some blood stored for transfusion at MRRH was inadequate, and the laboratory quality standard based on SLIPTA was low. Based on this, it is crucial to always insist on aseptic measures at all stages (phlebotomy, processing, transporting, and blood storage) and consider more assessment of the donor risk to minimize transfusion-transmitted malaria. It is plausible to standardize the hospital blood transfusion laboratory and revive hemovigilance by the hospital transfusion committee.

Keywords: Plasmodium species; SLIPTA; bacterial contamination; blood components; laboratory quality audit.

Figure 1

The WHO model algorithm for blood donor screening and confirmatory testing. Notes: Adapted with permission from: World Health Organization. Screening donated blood for transfusion-transmissible infections: recommendations. 2010; page 52; Figure 2. Available from: https://www.who.int/bloodsafety/ScreeningDonatedBloodforTransfusion.pdf. Accessed May 6, 2019.⁹ © World Health Organization 2010. All rights reserved. The red text represents the deferred donor category.