Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region,Paediatrics and International Child Health

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Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region
Paediatrics and International Child Health ( IF 1.8 ) Pub Date : 2021-04-19 , DOI: 10.1080/20469047.2021.1881270
Elizabeth M Keating _{1,

2} , Msandeni Chiume ₃ , Elizabeth Fitzgerald ₄ , Yamikani Mgusha ₃ , Tisungane Mvalo _{5,

6} , Nora Fino ₇ , Heather L Crouse ₈ , Michelle Eckerle _{9,

10} , Kathleen Gorman ₁₁ , Emily J Ciccone ₁₂ , Gladstone Airewele ₁₃ , Jeff A Robison ₁

Affiliation

Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, USA.
Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, USA.
Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi.
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of North Carolina, Chapel Hill, USA.
University of North Carolina Project Malawi, Lilongwe, Malawi.
Department of Pediatrics, University of North Carolina, School of Medicine, Chapel Hill, USA.
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, USA.
Department of Pediatrics, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, USA.
Department of Pediatrics, Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA.
London School of Hygiene and Tropical Medicine, London, UK.
Department of Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, USA.
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.

中文翻译：

疟疾流行地区严重贫血儿童的输血和死亡率

摘要

背景

在撒哈拉以南非洲的儿童中，严重贫血 (SA) 是导致死亡的重要原因，而疟疾是主要原因。世界卫生组织 (WHO) 建议所有血红蛋白 (Hb) <4 g/dL 和 Hb 4-6 g/dL 且有不稳定迹象的儿童输血。在撒哈拉以南非洲，输血对患有和不患有疟疾的 SA 儿童死亡率的影响的证据好坏参半。

目标

确定在患有和未患疟疾的儿童中接受输血是否与在世卫组织输血阈值下降低死亡率有关。

方法

这是一项回顾性队列研究，纳入马拉维卡穆祖中心医院的 1761 名 SA（Hb ≤6 g/dL）儿童。在 Hb 为 4-6 g/dL 的患者中，死亡率通过输血进行比较，按血红蛋白、疟疾状态和不稳定迹象分层。

结果

患有严重贫血（Hb <4 g/dL）和疟疾的儿童是唯一一个接受输血后院内死亡几率显着降低的亚组（OR 0.43，p = 0.01）。尽管 Hb 为 4-6 g/dL 且至少有一个不稳定迹象的儿童的死亡率高于没有的儿童，但接受输血的儿童和未接受输血的儿童的死亡率没有差异（OR 1.16，p = 0.62)。