Quality of Packed Red Blood Cells at Regional Blood Transfusion Center Nairobi

Abstract

Blood is composed of red and white blood cells, platelets and the fluid plasma. Whole blood can be separated into different components for the purpose of transfusion namely: packed red blood cells (PRBC), platelet concentrate, white cells preparations, cryoprecipitate and fresh frozen plasma (FFP). Component use enables maximum utilization of donated blood and reduction of adverse events that may range from mild allergic manifestation to fatal reactions. Preparation of the packed red cells component is the most well-known function of blood transfusion services in Kenya. The aim of the study was to assess the quality of packed red blood cells (PRBC) using the following parameters: volume, haematocrit, white blood cell count, red blood cell count and platelets. This was a descriptive cross-sectional study conducted in Nairobi Regional Blood Transfusion Center (NRBTC). Eighty PRBCs prepared as per the standard operating procedure used at NRBTC, were sampled. For each sample, the volume of the packed red blood cells was first determined. A 5ml aliquot of each PRBC sample was collected in Ethylene Diamine Tetra Acetic Acid (EDTA) tubes. The samples were then analyzed using a Sysmex XT 2000I analyzer. For hematocrit, total white blood cell count, platelet count and red blood cell count were determined. The data was collected and entered in a MS Excel sheet which was secured with a confidential password. The hard copies of the print outs from the machine were kept under lock and key, only accessible to the principal investigator. The results were analyzed in relation to acceptable reference ranges. The total of PRBCs within the acceptable ranges were 79 (99%) for volume, 43 (54%) for residual WBC count, 69 (86%) for RBC count, 61 (76%) for platelet count and 64 (80%) for haematocrit. Overall, out of the 80 PRBCs units prepared, with exclusion of platelets and WBC, only 54 (68%) met the quality requirements assessed. This was in agreement with other studies done where WBC count and platelets were not factored in. This study showed that following the standard operation procedures set by NRBTC, most of the PRBCs prepared met the quality assessment. However, the high residual WBC count requires to be addressed. In general, PRBCs should have residual WBC count of less than 5 x109/L. High residual WBC count is caused by the technical challenge of removal of the buffy coat during preparation of PRBCs following centrifugation and separation of blood components. This may be remedied by provision of additional continuous training to maintain quality standards. In addition, inclusion of leukodepletion filters would further enhance the PRBC quality by maintaining a low residual WBC count.