Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region.

IF 1.4 4区医学 Q3 PEDIATRICS

Paediatrics and International Child Health Pub Date : 2021-05-01 Epub Date: 2021-04-19 DOI:10.1080/20469047.2021.1881270

Elizabeth M Keating, Msandeni Chiume, Elizabeth Fitzgerald, Yamikani Mgusha, Tisungane Mvalo, Nora Fino, Heather L Crouse, Michelle Eckerle, Kathleen Gorman, Emily J Ciccone, Gladstone Airewele, Jeff A Robison

{"title":"Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region.","authors":"Elizabeth M Keating, Msandeni Chiume, Elizabeth Fitzgerald, Yamikani Mgusha, Tisungane Mvalo, Nora Fino, Heather L Crouse, Michelle Eckerle, Kathleen Gorman, Emily J Ciccone, Gladstone Airewele, Jeff A Robison","doi":"10.1080/20469047.2021.1881270","DOIUrl":null,"url":null,"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.","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"129-136"},"PeriodicalIF":1.4000,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8523581/pdf/nihms-1667283.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Paediatrics and International Child Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/20469047.2021.1881270","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/4/19 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

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.

查看原文本刊更多论文

疟疾流行地区严重贫血儿童的输血和死亡率。

背景：在撒哈拉以南非洲地区的儿童中，严重贫血（SA）是导致死亡的一个重要原因，而疟疾则是主要原因。世界卫生组织（WHO）建议为所有有血红蛋白（Hb）的儿童输血。目的：在患有和未患有疟疾的儿童中，确定接受输血是否与WHO输血阈值下的较低死亡率相关：这是一项回顾性队列研究，研究对象是马拉维卡穆祖中心医院收治的1761名患有SA（血红蛋白≤6 g/dL）的儿童。在血红蛋白为 4-6 g/dL 的儿童中，根据血红蛋白、疟疾状况和不稳定迹象对输血死亡率进行了比较：严重贫血的儿童（血红蛋白 p = 0.01）。虽然血红蛋白为 4-6 g/dL 且至少有一种不稳定迹象的儿童的死亡率高于无不稳定迹象的儿童，但接受输血和未接受输血的儿童的死亡几率没有差异（OR 1.16，p = 0.62）：这项研究表明，为患有严重贫血和疟疾的儿童输血可提高他们的院内存活率。了解与严重贫血死亡率相关的因素将有助于采取干预措施，优先提供有限的血液。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Paediatrics and International Child Health PEDIATRICS-

CiteScore

3.30

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Paediatrics and International Child Health is an international forum for all aspects of paediatrics and child health in developing and low-income countries. The international, peer-reviewed papers cover a wide range of diseases in childhood and examine the social and cultural settings in which they occur. Although the main aim is to enable authors in developing and low-income countries to publish internationally, it also accepts relevant papers from industrialised countries. The journal is a key publication for all with an interest in paediatric health in low-resource settings.