Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region. (3rd April 2021)

• Record Type: Journal Article
• Authors: Keating, Elizabeth M.; Chiume, Msandeni; Fitzgerald, Elizabeth; Mgusha, Yamikani; Mvalo, Tisungane; Fino, Nora; Crouse, Heather L.; Eckerle, Michelle; Gorman, Kathleen; Ciccone, Emily J.; Airewele, Gladstone; Robison, Jeff A.
• Is Part Of: Paediatrics and international child health. Volume 41:Number 2(2021)
• Page Start: 129
• Page End: 136
• Publication Date: 2021-04-03
• Subjects: Severe anaemia -- profound anaemia -- blood transfusion -- malaria -- sub-Saharan Africa -- mortality; Pediatrics -- Developing countries -- Periodicals; Children -- Health and hygiene -- Developing countries -- Periodicals; Children -- Diseases -- Developing countries -- Periodicals; 618.920009172405
• DOI: 10.1080/20469047.2021.1881270
• Languages: English
• ISSNs: 2046-9047

Abstract

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.