Assessment of Transfusion Trigger Practices for Red Cell Transfusion in Surgical Units at University of Ilorin Teaching Hospital, North Central Nigeria

This study assesses the clinical appropriateness of red cell transfusion triggers used in surgical units at the University of Ilorin Teaching Hospital (UITH), Kwara State, North Central Nigeria. Inappropriate red cell transfusion, whether over-transfusion in stable patients or under-transfusion in those with true clinical need, is a global challenge with implications for blood supply sustainability and patient safety. A retrospective audit of 300 surgical transfusion episodes over an 18-month period was conducted using structured data extraction forms. Transfusion triggers (haemoglobin threshold at which transfusion was ordered), clinical indication documentation, and patient outcomes were reviewed. Appropriateness was assessed against the British Society for Haematology (BSH) 2018 guidelines adapted for the Nigerian context. Findings showed that 61 percent of red cell transfusions were ordered at haemoglobin levels above 8 g/dL in haemodynamically stable patients, classified as potentially inappropriate. Clinical documentation justifying transfusion was absent in 34 percent of episode records. Post-transfusion haemoglobin reassessment was recorded in only 48 percent of cases. Obstetric and emergency surgical cases showed more appropriate trigger use than elective surgical cases. The study recommends implementation of a formal patient blood management programme, development of surgical transfusion trigger guidelines endorsed by the UITH clinical governance committee, and electronic decision support tools for transfusion ordering in surgical units. Keywords: transfusion trigger, red cell transfusion, patient blood management, surgical units, Ilorin.