Treatment of severe anaemia in children in a rural hospital.

Abstract

In a rural hospital in Malawi a protocol was developed for the treatment of severely anaemic children to improve the chances of survival of children with haemoglobin levels of 5 g/dl or less (referred to here as severe anaemia), and also to reduce the risks of transmission of human immunodeficiency virus (HIV) by blood transfusion in a unit where the routine screening of donated blood for HIV positivity is not available. Comparison of the results of applying the protocol (using digoxin, frusemide and selective delayed transfusion) with the results of using a widely accepted regimen of routine transfusion of all children with haemoglobin (Hb) of 5 g/dl or less suggests that stabilization of a severely anaemic child's cardiac state before transfusion improves the chances of survival. Many children with very low haemoglobin values do not then require transfusion, thus avoiding the dangers of transfusing blood that is potentially HIV positive. Those who do need transfusion withstand the procedure better.