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

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.