Abstract
BackgroundSevere anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group.MethodsWe present data from a large controlled trial of fluid resuscitation (Fluid Expansion As Supportive Therapy (FEAST) trial) on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness (predominantly malaria and/or sepsis) and impaired peripheral perfusion.ResultsOf 3,170 children in the FEAST trial, 3,082 (97%) had baseline haemoglobin (Hb) measurement, 2,346/3,082 (76%) were anaemic (Hb <10 g/dL), and 33% severely anaemic (Hb <5 g/dL). Prevalence of severe anaemia varied from 12% in Kenya to 41% in eastern Uganda. 1,387/3,082 (45%) children were transfused (81% within 8 hours). Adherence to WHO transfusion guidelines was poor. Among severely anaemic children who were not transfused, 52% (54/103) died within 8 hours, and 90% of these deaths occurred within 2.5 hours of randomisation. By 24 hours, 128/1,002 (13%) severely anaemic children had died, compared to 36/501 (7%) and 71/843 (8%) of those with moderate and mild anaemia, respectively. Among children without severe hypotension who were randomised to receive fluid boluses of 0.9% saline or albumin, mortality was increased (10.6% and 10.5%, respectively) compared to controls (7.2%), regardless of admission Hb level. Repeat transfusion varied from ≤2% in Kenya/Tanzania to 6 to 13% at the four Ugandan centres. Adverse reactions to blood were rare (0.4%).ConclusionsSevere anaemia complicates one third of childhood admissions with serious febrile illness to hospitals in East Africa, and is associated with increased mortality. A high proportion of deaths occurred within 2.5 hours of admission, emphasizing the need for rapid recognition and prompt blood transfusion. Adherence to current WHO transfusion guidelines was poor. The high rates of re-transfusion suggest that 20 mL/kg whole blood or 10 mL/kg packed cells may undertreat a significant proportion of anaemic children. Future evaluation of the impact of a larger volume of transfused blood and optimum transfusion management of children with Hb of <6 g/dL is warranted.Please see related article: http://dx.doi.org/10.1186/s12916-014-0248-5.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0246-7) contains supplementary material, which is available to authorized users.
Highlights
Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group
Malaria parasitaemia was present in 1,749/3,082 (57%) children, with a higher proportion of anaemic children being parasitaemic compared to non-anaemic children (59%, 75%, and 55% for severe, moderate, and mild anaemia, respectively, versus 43% for no anaemia; P
Current World Health Organization (WHO) transfusion guidelines [30] recommend 20 mL/kg of whole blood or 10 mL/kg packed cells for children with Hb ≤6 g/dL, yet standard calculations indicate that this under-treats children with profound anaemia (Hb
Summary
Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. In sub-Saharan Africa, severe anaemia in children is a leading cause of hospital admission, a major cause of mortality [1,2], and is responsible for a high proportion of the 660,000 malaria-related deaths that are estimated to occur each year [3,4]. There are limited published data on blood transfusion of anaemic children in sub-Saharan Africa, in relation to re-transfusion [9,10,11]. A large randomised controlled trial of fluid resuscitation (the Fluid Expansion As Supportive Therapy (FEAST) trial [12]) provided an opportunity to present quality-controlled data on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness and clinical signs of impaired peripheral perfusion
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
