Elizabeth M Keating1,2, Msandeni Chiume3, Elizabeth Fitzgerald4, Yamikani Mgusha3, Tisungane Mvalo5,6, Nora Fino7, Heather L Crouse8, Michelle Eckerle9,10, Kathleen Gorman11, Emily J Ciccone12, Gladstone Airewele13, Jeff A Robison1. 1. Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, USA. 2. Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, USA. 3. Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi. 4. Department of Pediatrics, Division of Pediatric Emergency Medicine, University of North Carolina, Chapel Hill, USA. 5. University of North Carolina Project Malawi, Lilongwe, Malawi. 6. Department of Pediatrics, University of North Carolina, School of Medicine, Chapel Hill, USA. 7. Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, USA. 8. Department of Pediatrics, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, USA. 9. Department of Pediatrics, Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, USA. 10. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA. 11. London School of Hygiene and Tropical Medicine, London, UK. 12. Department of Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, USA. 13. Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Houston, USA.
Abstract
BACKGROUND: In children in sub-Saharan Africa, severe anaemia (SA) is an important cause of mortality, and malaria is a primary cause. The World Health Organization (WHO) recommends blood transfusion for all children with haemoglobin (Hb) <4 g/dL and for those with Hb 4-6 g/dL with signs of instability. In sub-Saharan Africa, evidence of the effect on mortality of transfusion in children with SA with and without malaria is mixed. AIM: To determine in children with and without malaria whether receipt of transfusion was associated with lower mortality at WHO transfusion thresholds. METHODS: This was a retrospective cohort study of 1761 children with SA (Hb ≤6 g/dL) admitted to Kamuzu Central Hospital in Malawi. In those whose Hb was 4-6 g/dL, mortality was compared by transfusion, stratified by haemoglobin, malaria status and signs of instability. RESULTS: Children with profound anaemia (Hb <4 g/dL) and malaria were the only subgroup who had a significant decrease in the odds of in-hospital death if they received a transfusion (OR 0.43, p = 0.01). Although children with Hb 4-6 g/dL and at least one sign of instability had higher mortality than children with none, there was no difference in the odds of mortality between those who received a transfusion and those who did not (OR 1.16, p = 0.62). CONCLUSIONS: This study suggests that transfusion of children with profound anaemia and malaria may confer increased in-hospital survival. An understanding of the factors associated with mortality from SA will allow for interventions to prioritise the provision of limited blood.
BACKGROUND: In children in sub-Saharan Africa, severe anaemia (SA) is an important cause of mortality, and malaria is a primary cause. The World Health Organization (WHO) recommends blood transfusion for all children with haemoglobin (Hb) <4 g/dL and for those with Hb 4-6 g/dL with signs of instability. In sub-Saharan Africa, evidence of the effect on mortality of transfusion in children with SA with and without malaria is mixed. AIM: To determine in children with and without malaria whether receipt of transfusion was associated with lower mortality at WHO transfusion thresholds. METHODS: This was a retrospective cohort study of 1761 children with SA (Hb ≤6 g/dL) admitted to Kamuzu Central Hospital in Malawi. In those whose Hb was 4-6 g/dL, mortality was compared by transfusion, stratified by haemoglobin, malaria status and signs of instability. RESULTS: Children with profound anaemia (Hb <4 g/dL) and malaria were the only subgroup who had a significant decrease in the odds of in-hospital death if they received a transfusion (OR 0.43, p = 0.01). Although children with Hb 4-6 g/dL and at least one sign of instability had higher mortality than children with none, there was no difference in the odds of mortality between those who received a transfusion and those who did not (OR 1.16, p = 0.62). CONCLUSIONS: This study suggests that transfusion of children with profound anaemia and malaria may confer increased in-hospital survival. An understanding of the factors associated with mortality from SA will allow for interventions to prioritise the provision of limited blood.
Entities:
Keywords:
Severe anaemia; blood transfusion; malaria; mortality; profound anaemia; sub-Saharan Africa
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