Blood Transfusion Profile, Adverse Reactions, and Patient Perspectives at a Rwandan Tertiary Hospital: a mixed-methods study

Blood Transfusion Profile, Adverse Reactions, and Patient Perspectives at a Rwandan Tertiary Hospital: a mixed-methods study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Blood Transfusion Profile, Adverse Reactions, and Patient Perspectives at a Rwandan Tertiary Hospital: a mixed-methods study Eric Niyongira¹, Eric Niyomuremyi¹, Florence Masaisa², Wendy Uwase Gatoya¹, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8481824/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Blood transfusion is a critical intervention for severe anemia, hemorrhage, and other life-threatening conditions. However, transfusions carry risks such as circulatory overload, transfusion-related acute lung injury, and hemolytic reactions. Data on transfusion practices and patient perceptions in Rwanda are limited. This study aimed to characterize transfusion indications and adverse events, and assess patient knowledge and attitudes, in the internal medicine wards of the University Teaching Hospital of Kigali (CHUK). Methods: We performed a retrospective chart review of all adult patients (≥ 15 years) who received blood transfusions on the internal medicine wards from January 2020 through December 2021. Demographics, diagnoses, and documented transfusion reactions were recorded. Additionally, a prospective survey (April–May 2023) of transfused patients used a structured questionnaire to assess knowledge of indications, awareness of side effects, and willingness to accept transfusion. Data were analyzed using SPSS version 25; categorical variables were summarized as frequencies and percentages, and associations tested using chi-square or Fisher’s exact test as appropriate. Ethics approval was obtained from the University of Rwanda and CHUK, and informed consent was obtained for all interviews. Results: During the two years, 307 transfusions were given to 280 patients (51.5% female; 62% aged 30–65 years, mean ≈ 54 years). The most common underlying conditions were HIV infection (14.0%), chronic kidney disease (13.4%), and upper gastrointestinal bleeding or gastric cancer (~ 15% combined). Only 10 reactions (3.25%) were recorded, most frequently fever (0.6%). In the prospective survey (n = 71), 94.4% reported receiving a transfusion for anemia, 46.5% could not identify other indications, and 80.3% knew of no side effects. Despite limited knowledge, 88.7% were willing to accept transfusion if recommended, while 35.7% expressed concern about disease transmission. Post-transfusion symptoms included fever (7%), chills (5.6%), and dizziness (4.2%), while 70.4% reported none. Conclusions: In this tertiary-care Rwandan setting, blood transfusions were primarily used for chronic anemia associated with HIV and kidney disease. Documented adverse reactions were rare, though likely under-reported. Patients showed high acceptance but limited awareness of transfusion risks, underscoring the need for stronger hemovigilance and targeted patient education. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Blood transfusion Transfusion reactions Patient perception Haemovigilance Anaemia Rwanda. Figures Figure 1 Introduction Blood transfusion is an indispensable therapy for life-threatening anemia and hemorrhage[1]. Globally, tens of millions of red blood cell (RBC) units are transfused each year[2]. High-income countries contribute disproportionately: 40% of the 118.5 million global donations come from nations with 16% of the world’s population[1] [14] . In contrast, low-income countries face a heavy anemia burden (e.g. 40% of children and 30% of women globally)[3]. In sub-Saharan Africa, conditions like HIV, malaria, and malnutrition drive high transfusion demand. The World Health Organization emphasizes safe transfusion and supportive infrastructure (e.g., hemovigilance systems) to prevent and monitor adverse events[1]. Current guidelines advocate a restrictive transfusion strategy: randomized trials show that using hemoglobin thresholds of 7–8 g/dL (versus liberal thresholds of 9–10 g/dL) does not worsen outcomes[7][8]. Nevertheless, transfusions carry risks (e.g., febrile or hemolytic reactions, allergic reactions, transfusion-associated circulatory overload [TACO], and transfusion-related acute lung injury [TRALI])[4][9]. For example, U.S. data indicate that TACO accounts for ~ 34% of transfusion-related deaths and TRALI for ~ 21%[4]. In Rwanda, as in many African countries, systematic data on transfusion indications, complications, and patient views are sparse. Understanding local transfusion practice is important for improving safety. Patients’ knowledge and attitudes about transfusion may affect acceptance and reporting of side effects; studies elsewhere find variable awareness. For instance, in a sickle cell disease population, patients had general but incomplete knowledge about transfusion risks[10]. In Nigeria, about 80% of patients were willing to accept transfusions, though many feared infection[11]. This study examines transfusion records and patient perspectives at the University Teaching Hospital of Kigali (CHUK), Rwanda’s national referral center, to inform transfusion safety efforts. Methods This mixed retrospective-prospective study was conducted in the Internal Medicine Department of CHUK. Retrospective data : We reviewed medical records of all patients (≥ 15 years) who received at least one blood transfusion between January 1, 2020, and December 31, 2021. We extracted patient demographics, primary diagnoses, and any recorded transfusion reactions or complications from the charts. Cases were cross-checked against the hospital blood bank registry to ensure completeness. Prospective survey : From April to May 2023, we enrolled consecutive inpatients receiving transfusions. After obtaining informed consent, a structured questionnaire assessed demographics, transfusion history, knowledge of transfusion indications and side effects, source of information, and willingness to accept transfusion. Questions were read to participants in their preferred language if necessary. All aspects of the study received approval from the University of Rwanda College of Medicine and Health Sciences Institutional Review Board and the Research Ethics Committee of the University Teaching Hospital of Kigali (CHUK). Written informed consent was obtained from all participants prior to enrollment in the prospective survey. All procedures were conducted in accordance with relevant guidelines and regulations, including the Declaration of Helsinki. Data were entered into SPSS v26 (IBM Corp) and summarized using counts and percentages. No imputation was needed for missing values, given the descriptive aims. Results Retrospective transfusion profile Over a two-year period, 307 transfusions were administered to 280 patients. Table 1 presents the demographics, which show that roughly half of the participants were female (51.5%), and 62.0% were aged 30–65 (mean age ≈ approximately 54 years). The most common primary diagnoses at the time of transfusion were HIV-related anemia (14.0%), chronic kidney disease (13.4%), and conditions causing gastrointestinal blood loss (gastric cancer 8.3%, other upper GI bleeding 6.0%). Hypertension and diabetes were the diagnoses in 7.7% and 5.7%, respectively; 6 patients had known sickle cell disease (2.0%). Table 1 Sociodemographic Characteristics of Transfused Patients (Retrospective Review) Variable Frequency (n) Percentage (%) Gender Female 157 51.5 Male 148 48.5 Age groups 80 years 7 2.3 Note: Data were extracted from retrospective hospital records of patients transfused in the Internal Medicine Department of CHUK between January 2020 and December 2021. Percentages are based on the total number of transfused patients (n = 305). [Insert Fig. 1 here] Figure 1 . Main Diagnoses at the Time of Transfusion (N = 305) Horizontal bar chart showing both the absolute numbers (N) and percentages (%) of patients with each diagnosis at the time of transfusion. HIV-related anaemia (14%) and chronic kidney disease (13.4%) were the most frequent indications, followed by gastric cancer (8.3%), upper gastrointestinal bleeding (6.0%), hypertension (7.7%), diabetes (5.7%), and sickle-cell disease (2.0%). Other diagnoses accounted for 43% of cases. [Insert Table 1 here] Table 1 . Sociodemographic Characteristics of Transfused Patients (Retrospective Review) This table presents the age and gender distribution of 305 patients who received blood transfusions in the Internal Medicine Department at CHUK (2020–2021). The majority were aged 30–65 years (62%), and females represented 51.5% of transfused patients. Adverse reactions (retrospective) Only 10 of 307 transfusions (3.25%) had any documented reaction (Table 1 ). The most frequent event was fever (2 cases, 0.6%). Other recorded reactions (all single cases, 0.3% each) included shortness of breath, circulatory overload, hypotension, rash, and vomiting. No transfusion-associated lung injury or severe hemolysis was recorded. In summary, passively reported complications were infrequent. [Insert Table 2 here] Table 2 Documented Transfusion Reactions (Retrospective Data) Reaction Type Frequency (n) Percentage (%) Fever 2 0.6 Circulatory overload 1 0.3 Hypotension 1 0.3 Shortness of breath 1 0.3 Rash 1 0.3 Vomiting 1 0.3 Weakness / rash 1 0.3 Chest pain 1 0.3 Headache 1 0.3 Total 10 3.25 Note: Based on 307 transfusions performed during 2020–2021 in CHUK’s Internal Medicine Department. Each event was recorded in transfusion registers; percentages reflect proportions of total transfusions. Table 2 . Documented Transfusion Complications (Retrospective Data) Shows the types and frequency of adverse transfusion events recorded among 307 transfusions. Fever (0.6%) was the most common reaction, followed by circulatory overload, shortness of breath, and other minor reactions (each 0.3%). Patient survey (prospective) : Seventy-one transfused patients were surveyed. Their median age was 49 years, and 52.1% were ≥ 45 years. Education level was generally low: 11.3% had no formal schooling, 62.0% primary education, 22.5% secondary, and 4.2% tertiary. Most patients (77.5%) had 1–2 prior transfusions; only 7.0% had ≥ 4 transfusions. The indication for transfusion was low hemoglobin (anemia) in 94.4% of cases; bleeding was cited by only 5.6%. Nearly half (46.5%) said they did not know any reason for transfusion beyond anemia. [Insert Table 3 here] Table 3 Sociodemographic Characteristics (Prospective Study) Variable N Percentage (%) ≥ 45 years 37 52.1 15–34 years 19 26.8 35–44 years 15 21.1 No education 8 11.3 Primary 44 62.0 Secondary 16 22.5 University 3 4.2 Note: Derived from interviews with 71 patients prospectively surveyed after transfusion at CHUK (2021). Percentages are based on the total number of respondents (n = 71). Table 3 . Sociodemographic Characteristics of Transfused Patients (Prospective Survey) Summarizes the age distribution and education level of 71 patients surveyed prospectively after transfusion. More than half were ≥ 45 years (52.1%), and most had primary-level education (62%). Information sources varied: 64.8% of patients learned about transfusion while in the hospital, 28.2% from family or peers, and 5.6% via radio. A large majority (80.3%) reported no awareness of any transfusion side effects. When asked specifically, 35.7% expressed concern about contracting an infection from transfused blood. Regarding acceptance, 88.7% said they would agree to a transfusion if recommended (4.2% would refuse). Of those willing, 88.6% said they accepted willingly, while 11.4% felt it was “a last resort.” Symptoms experienced after transfusion were generally mild: fever (7.0%), chills/shaking (5.6%), itching (5.6%), dizziness (4.2%), shortness of breath (2.8%), and injection site pain or local rash (1.4%). No symptom was reported by 70.4% of respondents. [Insert Table 4 here] Table 4 Experiences and Viewpoints on Blood Transfusion Variable N Percentage (%) 1–2 transfusions 55 77.5 3–5 transfusions 10 14.1 > 5 transfusions 6 8.5 Low hemoglobin as reason 67 94.4 Bleeding as reason 4 5.6 Learnt from hospital staff 46 64.8 Learnt from family/friends 20 28.2 Learnt from radio/other 4 5.6 Fear of infection 25 35.7 Willing to accept transfusion 63 88.7 Note: Percentages calculated from 71 surveyed patients. Data capture patients’ transfusion experience, information sources, and attitudes. Table 4 . Experiences and Viewpoints on Blood Transfusion Describes patients’ experiences, reasons for transfusion, information sources, and attitudes toward blood transfusion. The majority had 1–2 previous transfusions (77.5%), learned about transfusion from hospital staff (64.8%), and expressed willingness to accept future transfusions (88.7%). [Insert Table 5 here] Table 5 Symptoms Experienced After Transfusion Symptom Yes (n) % No (n) % Fever 5 7.0 66 93.0 Chills 4 5.6 67 94.4 Pain 1 1.4 70 98.6 Itching 4 5.6 67 94.4 Dizziness 3 4.2 68 95.8 Erythema 1 1.4 70 98.6 Shortness of breath 2 2.8 69 97.2 None reported 50 70.4 21 29.6 Note: Data from 71 patients who received transfusions and were prospectively followed for post-transfusion symptoms. Most reactions were mild and self-limited. Table 5 . Signs and Symptoms Experienced After Transfusion Shows post-transfusion symptoms reported by the 71 surveyed patients. Most did not experience any adverse effects (70.4%), while mild fever (7%) and chills (5.6%) were the most frequently reported symptoms. Discussion This study provides a detailed look at transfusion practices in Rwanda’s national referral hospital. The patient profile – predominantly adults with chronic illnesses – matches Rwanda’s disease burden. HIV and chronic kidney disease were the leading indications, reflecting the high prevalence of anemia in HIV (often exceeding 30%)[3] and frequent need for transfusion in HIV-positive patients with advanced disease. Upper gastrointestinal bleeding (from peptic ulcer disease or cancer) was also common; bleeding disorders or surgery were rare, likely due to the internal medicine focus. By comparison, a U.S. ICU transfusion survey found chronic disease (e.g., anemia of chronic inflammation) common[2], whereas malaria-related anemia and obstetric hemorrhage often dominate in some African settings. Reported transfusion reactions were uncommon in this retrospective review (3.3%). This low rate likely underestimates true incidence, as passive chart review typically misses mild or unrecognized events. Prospective African studies have documented higher acute reaction rates (9.6% in Uganda[5], 21.3% in Ghana[6]). Our prospective patient data indeed found mild symptoms in ~ 30% of cases, suggesting that active monitoring identifies more reactions. Notably, no cases of TRALI or fatal hemolysis were observed, though TACO/febrile events were noted in surveys. In the U.S., hemovigilance data highlight TACO as the leading cause of transfusion-related deaths (34%) and TRALI as the second (21%)[4]. These severe reactions may have gone unrecognized here. The discrepancy underscores the importance of dedicated hemovigilance systems, as the WHO recommends, to capture and manage transfusion complications[1][12]. Patient perspectives revealed key gaps and strengths. Most respondents had very limited knowledge about transfusions beyond “for low blood.” This echoes findings from other settings: sickle cell patients were generally aware of transfusion as a concept but had misunderstandings about its purpose and risks[10]. Despite low knowledge, willingness to accept transfusion was high (88.7%), similar to 80% acceptance seen in a Nigerian hospital survey[11]. Fears about transfusion-transmitted infections were common (35.7% of our patients and 50% in Nigeria[11] [13] ), indicating mistrust despite overall acceptance. Only a small minority reported cultural or personal opposition. Notably, some misconceptions appeared: about 9% believed transfusion could change one’s character, a myth reported elsewhere but poorly studied. These perceptions highlight the need for better patient education and counselling. Patients in our study mainly learned about transfusion in the hospital, suggesting an opportunity for healthcare workers to provide accurate information and address concerns. Limitations The retrospective component depends on the completeness of medical records and underestimates minor reactions. The prospective survey covered a short period and a single unit, with a modest sample size, limiting generalizability. Self-reported symptoms may be subject to recall or social desirability bias. Nevertheless, our mixed-methods approach yields new insights into transfusion use and patient views in Rwanda. Conclusion In this Rwandan tertiary hospital setting, blood transfusions in internal medicine were most often given for anemia secondary to chronic diseases (HIV, kidney disease) and bleeding conditions. Recorded transfusion reactions were rare (< 3%), though active monitoring suggests a higher true incidence. Patients demonstrated a high willingness to accept transfusion but had limited knowledge of its indications and risks, and many harbored fears of disease transmission. These findings point to the need for strengthened transfusion safety measures – including systematic adverse event reporting – and enhanced patient education to improve transfusion outcomes in Rwanda. Declarations Ethics approval and consent to participate The study received ethical approval from the University of Rwanda–College of Medicine and Health Sciences (CMHS/323/2023) and the Research Ethics Committee of the University Teaching Hospital of Kigali (CHUK). Written informed consent was obtained from all participants. Consent for publication Not applicable. Availability of data and materials Data supporting the findings are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This work did not receive external funding. Informed consent: Written informed consent was obtained from all participants in the prospective survey. Authorship and contributions: EN and EN conceived the study; EN, EN, FM, WUG, and AA contributed to study design. EN and EN performed data collection. EN analyzed the data. EN drafted the manuscript. All authors reviewed and approved the final manuscript. EN is the guarantor of the work and takes responsibility for all aspects of the study. Acknowledgements We are grateful to Prof. Florence Masaisa for her guidance and mentorship, to CHUK staff for their support during data collection, and to all participants who took part in this study. Authors’ information Dr. Eric Niyongira, MD – Department of Primary Healthcare, University of Rwanda; Corresponding Author ( [email protected] ) Dr. Eric Niyomuremyi, MD – Department of Primary Healthcare, University of Rwanda Prof. Florence Masaisa, MD, MMed, PhD – Department of Internal Medicine, University Teaching Hospital of Kigali (CHUK) Dr. Wendy Uwase Gatoya, MD – Department of Primary Healthcare, University of Rwanda Dr. Annick Agasaro, MD – Department of Primary Healthcare, University of Rwanda References World Health Organization. Blood safety and availability. Geneva: WHO; 2025 [cited 2025 Oct 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availabilityhttps://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability World Health Organization. Anaemia – key facts. Geneva: WHO; 2025 [cited 2025 Oct 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/anaemia Carson JL, Stanworth SJ, Guyatt G, et al. Red Blood Cell Transfusion: 2023 AABB International Guidelines. JAMA . 2023;330(19):1892–1902[8]. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med . 2012;157(1):49–58[7]. US Food and Drug Administration. Fatalities Reported to FDA Following Blood Collection and Transfusion: Annual Summary for FY 2020. Silver Spring (MD): FDA; 2021 [cited 2025 Oct 1]. Available from: https://www.fda.gov/media/160859/download Waiswa MK, Moses A, Seremba E, Ddungu HD, Hume HA. Acute transfusion reactions at a national referral hospital in Uganda: a prospective study. Transfusion . 2014 Nov;54(11):2804–2810[5]. Owusu-Ofori AK, Owusu-Ofori SP, Bates I. Detection of adverse events of transfusion in a teaching hospital in Ghana. Transfus Med . 2017;27(3):175–180[6]. Oriyomi AD, Ayodeji SA, Olushola SM, Oladele OO, Abidemi AN. Attitude, beliefs and knowledge of patients towards blood transfusion practice in Osogbo, Southwestern Nigeria. IOSR J Dent Med Sci . 2015;14(10):74–79[11]. Lawrence RH, Singleton A, Branscomb J. Blood transfusion: knowledge, perspectives, and experience of individuals with sickle cell disease. J Patient Exp . 2020;7(6):1109–1114[10]. Frazier SK, Higgins J, Bugajski A, Jones AR, Brown MR. Adverse reactions to transfusion of blood products and best practices for prevention. Crit Care Nurs Clin North Am . 2017;29(3):271–290[9]. Wanko SO, Telen MJ. Transfusion management in sickle cell disease. Hematol Oncol Clin North Am . 2005;19(5):803–826. Aubron C, Aries P, Le Niger C, Sparrow RL, Ozier Y. How clinicians can minimize transfusion-related adverse events? Transfus Clin Biol . 2018;25(4):257–261. Jacquot C, Delaney M. Efforts toward elimination of infectious agents in blood products. J Intensive Care Med . 2018;33(10):543–550. World Health Organization. Global status report on blood safety and availability 2021 . Geneva: WHO; 2022. (Report based on 2018 data.) Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8481824","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":616091703,"identity":"fafc0c67-b22d-4128-9502-69fdaa2dbeb4","order_by":0,"name":"Eric Niyongira¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYDACZjApAcSMDQwfgBQbOylaGGeAtDCTZCMPwhDcwJydx/BxwS+LfH7pw42fbX5tk+djZmD88DEHtxbLZh5j45l9EpYz+xKbpXP7bhu2MTMwS87chluLwWEeM2neHgkDgzOMbcy5PbeBJNA7vMRosQdpsey5bU+cFp4fQFt4QOb/uJ1IhBa2YmPeBgkDiTOMzZK9DbeT25iBDLx+OX9442OeP3UG/D3sDz/8+HPbdn5788EPH/FoYWDgMGBgbIOyIQxgMsAP2B8wMPyBcf7gVDYKRsEoGAUjGAAACEdHmIUS7d8AAAAASUVORK5CYII=","orcid":"","institution":"University of Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Eric","middleName":"","lastName":"Niyongira¹","suffix":""},{"id":616091704,"identity":"25a5e5f9-99d2-4d75-aedf-a01f363c07be","order_by":1,"name":"Eric Niyomuremyi¹","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Eric","middleName":"","lastName":"Niyomuremyi¹","suffix":""},{"id":616091705,"identity":"44d63fba-62f8-4f07-a8b1-18f5cfce8496","order_by":2,"name":"Florence Masaisa²","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Kigali","correspondingAuthor":false,"prefix":"","firstName":"Florence","middleName":"","lastName":"Masaisa²","suffix":""},{"id":616091706,"identity":"47cfb121-4015-4de5-9437-9f47c3b9a5d0","order_by":3,"name":"Wendy Uwase Gatoya¹","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Wendy","middleName":"Uwase","lastName":"Gatoya¹","suffix":""},{"id":616091707,"identity":"e6c25447-9f88-4061-be85-bd556664230b","order_by":4,"name":"Annick Agasaro¹","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Annick","middleName":"","lastName":"Agasaro¹","suffix":""}],"badges":[],"createdAt":"2025-12-30 13:38:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8481824/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8481824/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106309898,"identity":"dcf7443f-fa14-4da8-9da7-ccc046c63483","added_by":"auto","created_at":"2026-04-07 10:20:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114934,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMain Diagnoses at the time of Transfusion(N = 305)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote:\u003c/em\u003e Data derived from retrospective review of 305 patients transfused in the Internal Medicine Department at CHUK between 2020 and 2021; percentages are relative to total transfused patients.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8481824/v1/6136bd0aea9eac52fda35e74.png"},{"id":106402928,"identity":"3c080a1c-1fcc-4a64-9bc4-cfc44b93a9ad","added_by":"auto","created_at":"2026-04-08 09:13:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":764794,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8481824/v1/2bd93281-cb0e-405a-8eb1-e625a3c96bb0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Blood Transfusion Profile, Adverse Reactions, and Patient Perspectives at a Rwandan Tertiary Hospital: a mixed-methods study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBlood transfusion is an indispensable therapy for life-threatening anemia and hemorrhage[1]. Globally, tens of millions of red blood cell (RBC) units are transfused each year[2]. High-income countries contribute disproportionately: 40% of the 118.5\u0026nbsp;million global donations come from nations with 16% of the world\u0026rsquo;s population[1] \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[14]\u003c/span\u003e. In contrast, low-income countries face a heavy anemia burden (e.g. 40% of children and 30% of women globally)[3]. In sub-Saharan Africa, conditions like HIV, malaria, and malnutrition drive high transfusion demand. The World Health Organization emphasizes safe transfusion and supportive infrastructure (e.g., hemovigilance systems) to prevent and monitor adverse events[1]. Current guidelines advocate a restrictive transfusion strategy: randomized trials show that using hemoglobin thresholds of 7\u0026ndash;8 g/dL (versus liberal thresholds of 9\u0026ndash;10 g/dL) does not worsen outcomes[7][8]. Nevertheless, transfusions carry risks (e.g., febrile or hemolytic reactions, allergic reactions, transfusion-associated circulatory overload [TACO], and transfusion-related acute lung injury [TRALI])[4][9]. For example, U.S. data indicate that TACO accounts for ~\u0026thinsp;34% of transfusion-related deaths and TRALI for ~\u0026thinsp;21%[4].\u003c/p\u003e \u003cp\u003eIn Rwanda, as in many African countries, systematic data on transfusion indications, complications, and patient views are sparse. Understanding local transfusion practice is important for improving safety. Patients\u0026rsquo; knowledge and attitudes about transfusion may affect acceptance and reporting of side effects; studies elsewhere find variable awareness. For instance, in a sickle cell disease population, patients had general but incomplete knowledge about transfusion risks[10]. In Nigeria, about 80% of patients were willing to accept transfusions, though many feared infection[11]. This study examines transfusion records and patient perspectives at the University Teaching Hospital of Kigali (CHUK), Rwanda\u0026rsquo;s national referral center, to inform transfusion safety efforts.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eThis mixed retrospective-prospective study was conducted in the Internal Medicine Department of CHUK. \u003cem\u003eRetrospective data\u003c/em\u003e: We reviewed medical records of all patients (\u0026ge;\u0026thinsp;15 years) who received at least one blood transfusion between January 1, 2020, and December 31, 2021. We extracted patient demographics, primary diagnoses, and any recorded transfusion reactions or complications from the charts. Cases were cross-checked against the hospital blood bank registry to ensure completeness. \u003cem\u003eProspective survey\u003c/em\u003e: From April to May 2023, we enrolled consecutive inpatients receiving transfusions. After obtaining informed consent, a structured questionnaire assessed demographics, transfusion history, knowledge of transfusion indications and side effects, source of information, and willingness to accept transfusion. Questions were read to participants in their preferred language if necessary.\u003c/p\u003e \u003cp\u003e All aspects of the study received approval from the University of Rwanda College of Medicine and Health Sciences Institutional Review Board and the Research Ethics Committee of the University Teaching Hospital of Kigali (CHUK). Written informed consent was obtained from all participants prior to enrollment in the prospective survey. All procedures were conducted in accordance with relevant guidelines and regulations, including the Declaration of Helsinki. Data were entered into SPSS v26 (IBM Corp) and summarized using counts and percentages. No imputation was needed for missing values, given the descriptive aims.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cstrong\u003eRetrospective transfusion profile\u003c/strong\u003e \u003cp\u003eOver a two-year period, 307 transfusions were administered to 280 patients. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographics, which show that roughly half of the participants were female (51.5%), and 62.0% were aged 30\u0026ndash;65 (mean age\u0026thinsp;\u0026asymp;\u0026thinsp;approximately 54 years). The most common primary diagnoses at the time of transfusion were HIV-related anemia (14.0%), chronic kidney disease (13.4%), and conditions causing gastrointestinal blood loss (gastric cancer 8.3%, other upper GI bleeding 6.0%). Hypertension and diabetes were the diagnoses in 7.7% and 5.7%, respectively; 6 patients had known sickle cell disease (2.0%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic Characteristics of Transfused Patients (Retrospective Review)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge groups\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e66\u0026ndash;80 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;80 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cem\u003eNote:\u003c/em\u003e Data were extracted from retrospective hospital records of patients transfused in the Internal Medicine Department of CHUK between January 2020 and December 2021. Percentages are based on the total number of transfused patients (n = 305).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e[Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Main Diagnoses at the Time of Transfusion (N\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e \u003cp\u003eHorizontal bar chart showing both the absolute numbers (N) and percentages (%) of patients with each diagnosis at the time of transfusion. HIV-related anaemia (14%) and chronic kidney disease (13.4%) were the most frequent indications, followed by gastric cancer (8.3%), upper gastrointestinal bleeding (6.0%), hypertension (7.7%), diabetes (5.7%), and sickle-cell disease (2.0%). Other diagnoses accounted for 43% of cases.\u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Sociodemographic Characteristics of Transfused Patients (Retrospective Review)\u003c/p\u003e \u003cp\u003eThis table presents the age and gender distribution of 305 patients who received blood transfusions in the Internal Medicine Department at CHUK (2020\u0026ndash;2021). The majority were aged 30\u0026ndash;65 years (62%), and females represented 51.5% of transfused patients.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAdverse reactions (retrospective)\u003c/strong\u003e \u003cp\u003eOnly 10 of 307 transfusions (3.25%) had any documented reaction (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The most frequent event was fever (2 cases, 0.6%). Other recorded reactions (all single cases, 0.3% each) included shortness of breath, circulatory overload, hypotension, rash, and vomiting. No transfusion-associated lung injury or severe hemolysis was recorded. In summary, passively reported complications were infrequent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDocumented Transfusion Reactions (Retrospective Data)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReaction Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirculatory overload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypotension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShortness of breath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeakness / rash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003eNote:\u003c/em\u003e Based on 307 transfusions performed during 2020\u0026ndash;2021 in CHUK\u0026rsquo;s Internal Medicine Department. Each event was recorded in transfusion registers; percentages reflect proportions of total transfusions.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Documented Transfusion Complications (Retrospective Data)\u003c/p\u003e \u003cp\u003eShows the types and frequency of adverse transfusion events recorded among 307 transfusions. Fever (0.6%) was the most common reaction, followed by circulatory overload, shortness of breath, and other minor reactions (each 0.3%).\u003c/p\u003e \u003cp\u003e \u003cb\u003ePatient survey (prospective)\u003c/b\u003e: Seventy-one transfused patients were surveyed. Their median age was 49 years, and 52.1% were \u0026ge;\u0026thinsp;45 years. Education level was generally low: 11.3% had no formal schooling, 62.0% primary education, 22.5% secondary, and 4.2% tertiary. Most patients (77.5%) had 1\u0026ndash;2 prior transfusions; only 7.0% had\u0026thinsp;\u0026ge;\u0026thinsp;4 transfusions. The indication for transfusion was low hemoglobin (anemia) in 94.4% of cases; bleeding was cited by only 5.6%. Nearly half (46.5%) said they did not know any reason for transfusion beyond anemia.\u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic Characteristics (Prospective Study)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003eNote:\u003c/em\u003e Derived from interviews with 71 patients prospectively surveyed after transfusion at CHUK (2021). Percentages are based on the total number of respondents (n = 71).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Sociodemographic Characteristics of Transfused Patients (Prospective Survey)\u003c/p\u003e \u003cp\u003eSummarizes the age distribution and education level of 71 patients surveyed prospectively after transfusion. More than half were \u0026ge;\u0026thinsp;45 years (52.1%), and most had primary-level education (62%).\u003c/p\u003e \u003cp\u003eInformation sources varied: 64.8% of patients learned about transfusion while in the hospital, 28.2% from family or peers, and 5.6% via radio. A large majority (80.3%) reported no awareness of any transfusion side effects. When asked specifically, 35.7% expressed concern about contracting an infection from transfused blood. Regarding acceptance, 88.7% said they would agree to a transfusion if recommended (4.2% would refuse). Of those willing, 88.6% said they accepted willingly, while 11.4% felt it was \u0026ldquo;a last resort.\u0026rdquo; Symptoms experienced after transfusion were generally mild: fever (7.0%), chills/shaking (5.6%), itching (5.6%), dizziness (4.2%), shortness of breath (2.8%), and injection site pain or local rash (1.4%). No symptom was reported by 70.4% of respondents.\u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExperiences and Viewpoints on Blood Transfusion\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 transfusions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5 transfusions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 transfusions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow hemoglobin as reason\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding as reason\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearnt from hospital staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearnt from family/friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearnt from radio/other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWilling to accept transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003eNote:\u003c/em\u003e Percentages calculated from 71 surveyed patients. Data capture patients\u0026rsquo; transfusion experience, information sources, and attitudes.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Experiences and Viewpoints on Blood Transfusion\u003c/p\u003e \u003cp\u003eDescribes patients\u0026rsquo; experiences, reasons for transfusion, information sources, and attitudes toward blood transfusion. The majority had 1\u0026ndash;2 previous transfusions (77.5%), learned about transfusion from hospital staff (64.8%), and expressed willingness to accept future transfusions (88.7%).\u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSymptoms Experienced After Transfusion\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptom\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e93.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e98.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDizziness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e95.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErythema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e98.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShortness of breath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e97.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003eNote:\u003c/em\u003e Data from 71 patients who received transfusions and were prospectively followed for post-transfusion symptoms. Most reactions were mild and self-limited.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Signs and Symptoms Experienced After Transfusion\u003c/p\u003e \u003cp\u003eShows post-transfusion symptoms reported by the 71 surveyed patients. Most did not experience any adverse effects (70.4%), while mild fever (7%) and chills (5.6%) were the most frequently reported symptoms.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a detailed look at transfusion practices in Rwanda\u0026rsquo;s national referral hospital. The patient profile \u0026ndash; predominantly adults with chronic illnesses \u0026ndash; matches Rwanda\u0026rsquo;s disease burden. HIV and chronic kidney disease were the leading indications, reflecting the high prevalence of anemia in HIV (often exceeding 30%)[3] and frequent need for transfusion in HIV-positive patients with advanced disease. Upper gastrointestinal bleeding (from peptic ulcer disease or cancer) was also common; bleeding disorders or surgery were rare, likely due to the internal medicine focus. By comparison, a U.S. ICU transfusion survey found chronic disease (e.g., anemia of chronic inflammation) common[2], whereas malaria-related anemia and obstetric hemorrhage often dominate in some African settings.\u003c/p\u003e \u003cp\u003eReported transfusion reactions were uncommon in this retrospective review (3.3%). This low rate likely underestimates true incidence, as passive chart review typically misses mild or unrecognized events. Prospective African studies have documented higher acute reaction rates (9.6% in Uganda[5], 21.3% in Ghana[6]). Our prospective patient data indeed found mild symptoms in ~\u0026thinsp;30% of cases, suggesting that active monitoring identifies more reactions. Notably, no cases of TRALI or fatal hemolysis were observed, though TACO/febrile events were noted in surveys. In the U.S., hemovigilance data highlight TACO as the leading cause of transfusion-related deaths (34%) and TRALI as the second (21%)[4]. These severe reactions may have gone unrecognized here. The discrepancy underscores the importance of dedicated hemovigilance systems, as the WHO recommends, to capture and manage transfusion complications[1][12].\u003c/p\u003e \u003cp\u003ePatient perspectives revealed key gaps and strengths. Most respondents had very limited knowledge about transfusions beyond \u0026ldquo;for low blood.\u0026rdquo; This echoes findings from other settings: sickle cell patients were generally aware of transfusion as a concept but had misunderstandings about its purpose and risks[10]. Despite low knowledge, willingness to accept transfusion was high (88.7%), similar to 80% acceptance seen in a Nigerian hospital survey[11]. Fears about transfusion-transmitted infections were common (35.7% of our patients and 50% in Nigeria[11] \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[13]\u003c/span\u003e), indicating mistrust despite overall acceptance. Only a small minority reported cultural or personal opposition. Notably, some misconceptions appeared: about 9% believed transfusion could change one\u0026rsquo;s character, a myth reported elsewhere but poorly studied. These perceptions highlight the need for better patient education and counselling. Patients in our study mainly learned about transfusion in the hospital, suggesting an opportunity for healthcare workers to provide accurate information and address concerns.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eThe retrospective component depends on the completeness of medical records and underestimates minor reactions. The prospective survey covered a short period and a single unit, with a modest sample size, limiting generalizability. Self-reported symptoms may be subject to recall or social desirability bias. Nevertheless, our mixed-methods approach yields new insights into transfusion use and patient views in Rwanda.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this Rwandan tertiary hospital setting, blood transfusions in internal medicine were most often given for anemia secondary to chronic diseases (HIV, kidney disease) and bleeding conditions. Recorded transfusion reactions were rare (\u0026lt;\u0026thinsp;3%), though active monitoring suggests a higher true incidence. Patients demonstrated a high willingness to accept transfusion but had limited knowledge of its indications and risks, and many harbored fears of disease transmission. These findings point to the need for strengthened transfusion safety measures \u0026ndash; including systematic adverse event reporting \u0026ndash; and enhanced patient education to improve transfusion outcomes in Rwanda.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the University of Rwanda\u0026ndash;College of Medicine and Health Sciences (CMHS/323/2023) and the Research Ethics Committee of the University Teaching Hospital of Kigali (CHUK). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting the findings are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work did not receive external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants in the prospective survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship and contributions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEN and EN conceived the study; EN, EN, FM, WUG, and AA contributed to study design. EN and EN performed data collection. EN analyzed the data. EN drafted the manuscript. All authors reviewed and approved the final manuscript. EN is the guarantor of the work and takes responsibility for all aspects of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to Prof. Florence Masaisa for her guidance and mentorship, to CHUK staff for their support during data collection, and to all participants who took part in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Eric Niyongira, MD \u0026ndash; Department of Primary Healthcare, University of Rwanda; Corresponding Author ([email protected])\u003c/p\u003e\n\u003cp\u003eDr. Eric Niyomuremyi, MD \u0026ndash; Department of Primary Healthcare, University of Rwanda\u003c/p\u003e\n\u003cp\u003eProf. Florence Masaisa, MD, MMed, PhD \u0026ndash; Department of Internal Medicine, University Teaching Hospital of Kigali (CHUK)\u003c/p\u003e\n\u003cp\u003eDr. Wendy Uwase Gatoya, MD \u0026ndash; Department of Primary Healthcare, University of Rwanda\u003c/p\u003e\n\u003cp\u003eDr. Annick Agasaro, MD \u0026ndash; Department of Primary Healthcare, University of Rwanda\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eWorld Health Organization. Blood safety and availability. Geneva: WHO; 2025 [cited 2025 Oct 1]. Available from: \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availabilityhttps://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWorld Health Organization. Anaemia \u0026ndash; key facts. Geneva: WHO; 2025 [cited 2025 Oct 1]. Available from: \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/anaemia\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCarson JL, Stanworth SJ, Guyatt G, et al. Red Blood Cell Transfusion: 2023 AABB International Guidelines. \u003cem\u003eJAMA\u003c/em\u003e. 2023;330(19):1892\u0026ndash;1902[8].\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCarson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. \u003cem\u003eAnn Intern Med\u003c/em\u003e. 2012;157(1):49\u0026ndash;58[7].\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eUS Food and Drug Administration. Fatalities Reported to FDA Following Blood Collection and Transfusion: Annual Summary for FY 2020. Silver Spring (MD): FDA; 2021 [cited 2025 Oct 1]. Available from: \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://www.fda.gov/media/160859/download\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWaiswa MK, Moses A, Seremba E, Ddungu HD, Hume HA. Acute transfusion reactions at a national referral hospital in Uganda: a prospective study. \u003cem\u003eTransfusion\u003c/em\u003e. 2014 Nov;54(11):2804\u0026ndash;2810[5].\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOwusu-Ofori AK, Owusu-Ofori SP, Bates I. Detection of adverse events of transfusion in a teaching hospital in Ghana. \u003cem\u003eTransfus Med\u003c/em\u003e. 2017;27(3):175\u0026ndash;180[6].\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOriyomi AD, Ayodeji SA, Olushola SM, Oladele OO, Abidemi AN. Attitude, beliefs and knowledge of patients towards blood transfusion practice in Osogbo, Southwestern Nigeria. \u003cem\u003eIOSR J Dent Med Sci\u003c/em\u003e. 2015;14(10):74\u0026ndash;79[11].\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLawrence RH, Singleton A, Branscomb J. Blood transfusion: knowledge, perspectives, and experience of individuals with sickle cell disease. \u003cem\u003eJ Patient Exp\u003c/em\u003e. 2020;7(6):1109\u0026ndash;1114[10].\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFrazier SK, Higgins J, Bugajski A, Jones AR, Brown MR. Adverse reactions to transfusion of blood products and best practices for prevention. \u003cem\u003eCrit Care Nurs Clin North Am\u003c/em\u003e. 2017;29(3):271\u0026ndash;290[9].\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWanko SO, Telen MJ. Transfusion management in sickle cell disease. \u003cem\u003eHematol Oncol Clin North Am\u003c/em\u003e. 2005;19(5):803\u0026ndash;826.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAubron C, Aries P, Le Niger C, Sparrow RL, Ozier Y. How clinicians can minimize transfusion-related adverse events? \u003cem\u003eTransfus Clin Biol\u003c/em\u003e. 2018;25(4):257\u0026ndash;261.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJacquot C, Delaney M. Efforts toward elimination of infectious agents in blood products. \u003cem\u003eJ Intensive Care Med\u003c/em\u003e. 2018;33(10):543\u0026ndash;550.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWorld Health Organization. \u003cem\u003eGlobal status report on blood safety and availability 2021\u003c/em\u003e. Geneva: WHO; 2022. (Report based on 2018 data.)\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Blood transfusion, Transfusion reactions, Patient perception, Haemovigilance, Anaemia, Rwanda.","lastPublishedDoi":"10.21203/rs.3.rs-8481824/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8481824/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eBlood transfusion is a critical intervention for severe anemia, hemorrhage, and other life-threatening conditions. However, transfusions carry risks such as circulatory overload, transfusion-related acute lung injury, and hemolytic reactions. Data on transfusion practices and patient perceptions in Rwanda are limited. This study aimed to characterize transfusion indications and adverse events, and assess patient knowledge and attitudes, in the internal medicine wards of the University Teaching Hospital of Kigali (CHUK).\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e We performed a retrospective chart review of all adult patients (\u0026ge;\u0026thinsp;15 years) who received blood transfusions on the internal medicine wards from January 2020 through December 2021. Demographics, diagnoses, and documented transfusion reactions were recorded. Additionally, a prospective survey (April\u0026ndash;May 2023) of transfused patients used a structured questionnaire to assess knowledge of indications, awareness of side effects, and willingness to accept transfusion. Data were analyzed using SPSS version 25; categorical variables were summarized as frequencies and percentages, and associations tested using chi-square or Fisher\u0026rsquo;s exact test as appropriate. Ethics approval was obtained from the University of Rwanda and CHUK, and informed consent was obtained for all interviews.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eDuring the two years, 307 transfusions were given to 280 patients (51.5% female; 62% aged 30\u0026ndash;65 years, mean\u0026thinsp;\u0026asymp;\u0026thinsp;54 years). The most common underlying conditions were HIV infection (14.0%), chronic kidney disease (13.4%), and upper gastrointestinal bleeding or gastric cancer (~\u0026thinsp;15% combined). Only 10 reactions (3.25%) were recorded, most frequently fever (0.6%). In the prospective survey (n\u0026thinsp;=\u0026thinsp;71), 94.4% reported receiving a transfusion for anemia, 46.5% could not identify other indications, and 80.3% knew of no side effects. Despite limited knowledge, 88.7% were willing to accept transfusion if recommended, while 35.7% expressed concern about disease transmission. Post-transfusion symptoms included fever (7%), chills (5.6%), and dizziness (4.2%), while 70.4% reported none.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eIn this tertiary-care Rwandan setting, blood transfusions were primarily used for chronic anemia associated with HIV and kidney disease. Documented adverse reactions were rare, though likely under-reported. Patients showed high acceptance but limited awareness of transfusion risks, underscoring the need for stronger hemovigilance and targeted patient education.\u003c/p\u003e","manuscriptTitle":"Blood Transfusion Profile, Adverse Reactions, and Patient Perspectives at a Rwandan Tertiary Hospital: a mixed-methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 10:20:35","doi":"10.21203/rs.3.rs-8481824/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-06T13:26:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295803637490915460612406334093899960343","date":"2026-05-06T12:07:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27975100515855964135665497611330015539","date":"2026-04-12T02:52:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-09T16:40:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24225453892070686571428438001060201866","date":"2026-04-09T12:16:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T10:18:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T17:41:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-06T11:35:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-05T10:19:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-01-05T10:04:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85c605e5-99b6-43c7-9852-37e78a22cac6","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-06T13:26:17+00:00","index":90,"fulltext":""},{"type":"reviewerAgreed","content":"295803637490915460612406334093899960343","date":"2026-05-06T12:07:10+00:00","index":89,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":65561474,"name":"Health sciences/Diseases"},{"id":65561475,"name":"Health sciences/Health care"},{"id":65561476,"name":"Health sciences/Medical research"},{"id":65561477,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-04-07T10:20:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 10:20:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8481824","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8481824","identity":"rs-8481824","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}