Use of clinical judgement to guide administration of blood transfusions inMalawi

The aim of this study was to investigate whether clinicians in Malawi could use clinical judgement alone to administer blood transfusions in accordanc e with guidelines. Clinicians at a district hospital did not use the Lovibo nd Comparator haemoglobin results provided by their laboratory as they felt them to be unreliable, preferring instead to rely on their clinical judgem ent alone to guide transfusion practice. Their transfusion practice and the Lovibond haemoglobin results were monitored against the World Health Organ ization recommended haemiglobincyanide method for haemoglobin measurement w ithout the clinicians having access to this result. The Lovibond Comparator method was shown to have a sensitivity of only 21 % to detect trigger haem oglobin values for transfusion published in local guidelines. Without acces s to a useful haemoglobin result, clinicians gave 67% of transfusions in ac cordance with the haemoglobin trigger values in the guidelines. This study shows that clinical features alone can provide a reasonable guide about the need for transfusion, and that poor quality laboratory tests limit the eff ectiveness of transfusion guidelines.