Survival and haematological recovery of children with severe malaria transfused in accordance to WHO guidelines in Kilifi, Kenya

Akech, S. O., Hassall, Oliver, Pamba, A., Idro, R., Williams, T. N., Newton, C. R. J. C. and Maitland, K. (2008) 'Survival and haematological recovery of children with severe malaria transfused in accordance to WHO guidelines in Kilifi, Kenya'. Malaria Journal, Vol 7, Issue 256.

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Abstract

Background: Severe anaemia requiring emergency blood transfusion is a common complication of malaria in children. To ensure access for urgent blood transfusion, the World Health Organization has developed clear guidelines with haemoglobin thresholds prevent unwarranted transfusion,. Few studies have reported outcome and haematological recovery of children with severe malaria where transfusion practice complies with WHO recommendations.
Methods: A prospective observational study of survivors of severe and complicated malaria transfused in accordance with WHO guidelines. Children were invited for review at one month post-discharge. Non-attendees were traced in the community to ascertain survival.
Results: Outcome was assessed in 213 survivors. Those transfused were younger, had a higher base deficit, mean lactate levels and a higher prevalence of respiratory distress. As expected mean admission haemoglobin (Hb) was significantly lower amongst transfused [5.0 g/dL SD: 1.9] compared to non-transfused children [8.3 g/dL SD: 1.7] (p < 0.001). At discharge mean Hb was similar 6.4 g/dL [SD: 1.5] and 6.8 g/dL [SD: 1.6] respectively (p = 0.08), most children remained moderately to severely anaemic. At one month follow up 166 children (78%) returned, in whom we found no differences in mean Hb between the transfused (10.2 g/dL [SD: 1.7]) and non-transfused (10.0 g/dL [SD: 1.3]) survivors ( p = 0.25). The major factors affecting haematological recovery were young age (< 24 months) and concomitant malaria parasitaemia; Hb being 8.8 g/dL [SD: 1.5] in parasitaemic individuals compared with 10.5 g/dL [SD: 1.3] in those without (p < 0.001).
Conclusion: This data supports the policy of rational use of blood transfusion, as proposed in the WHO guidelines, for children with anaemia in areas where access to emergency transfusion is not guaranteed. We have provided empirical data indicating that transfusion does not influence superior recovery in haemoglobin concentrations and therefore cannot be justified on this basis alone. This may help resolve the disparity between international policy and current clinical practice. Effective anti- malarial treatment at discharge may prevent reoccurrence of anaemia.

Item Type:	Article
Uncontrolled Keywords:	plasmodium-falciparum malaria blood-transfusion volume expansion severe anemia gambian children controlled-trial endemic area coast transmission management
Subjects:	WB Practice of Medicine > Therapeutics > WB 300 General works WS Pediatrics > WS 20 Research (General) WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria QX Parasitology > Protozoa > QX 135 Plasmodia WS Pediatrics > Diseases of Children and Adolescents > By System > WS 300 Hemic and lymphatic system WH Hemic and Lymphatic Systems > WH 20 Research (General)
Faculty: Department:	Groups (2002 - 2012) > Disease Control Strategy Group
Digital Object Identifer (DOI):	https://doi.org/10.1186/1475-2875-7-256
Depositing User:	Tina Bowers
Date Deposited:	18 Mar 2010 12:25
Last Modified:	06 Feb 2018 13:00
URI:	https://archive.lstmed.ac.uk/id/eprint/715

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