Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness

BMC Medicine

Jane Crawley³  Diana M Gibb²  Abdel G Babiker²  Michael Levin⁹  Hugh Reyburn¹  George Mtove¹  Richard Nyeko⁵  Samuel O Akech⁷  Charles Engoru⁸  Robert O Opoka⁶  Peter Olupot-Olupot⁴  Elizabeth C George²  Kathryn Maitland⁹  Sarah Kiguli⁶ 

[1] Department of Paediatrics, Joint Malaria Programme, Teule Hospital, Muheza, Tanzania;Medical Research Council Clinical Trials Unit (MRC CTU) at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK;Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LD, UK;Department of Paediatrics, Mbale Regional Referral Hospital, Pallisa Road Zone, Mbale, Uganda;Department of Paediatrics, St Mary’s Hospital, Lacor, Uganda;Department of Paediatrics, Mulago Hospital, Makerere University, Kampala, Uganda;Kilifi Clinical Trials Facility, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya;Department of Paediatrics, Soroti Regional Referral Hospital, Soroti, Uganda;Wellcome Trust Centre for Clinical Tropical Medicine, and Department of Paediatrics, Faculty of Medicine, Imperial College, London W2 1PG, UK

关键词: Sepsis;    Malaria;    FEAST trial;    Children;    Blood transfusion;    Anaemia;    Africa;   

Others  :  1109685
DOI  :  10.1186/s12916-014-0246-7

 received in 2014-09-16, accepted in 2014-12-08,  发布年份 2015

【 摘 要 】

Background

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.

Methods

We 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.

Results

Of 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%).

Conclusions

Severe 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.

【 授权许可】

   
2015 Kiguli et al.; licensee BioMed Central.

【 图 表 】

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