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Published on: July 11, 2019
Effect of blood transfusion on survival among children in a Kenyan hospital
E M Lackritz1, C C Campbell, T K Ruebush
1Division of Parasitic Diseases, Centers for Disease Control, Atlanta, Georgia 30333.
Insights
Blood transfusions save lives in children with severe anaemia in Kenya. Early transfusion for anaemic children with respiratory distress significantly reduces mortality risk, optimizing blood use.
Area of Science:
- Paediatric Medicine
- Haematology
- Public Health in Africa
Background:
- Severe paediatric anaemia is a major cause of mortality in Africa.
- Blood transfusions are a critical intervention but carry risks like HIV transmission.
- Identifying optimal transfusion criteria is vital for improving survival rates in severely anaemic children.
Purpose of the Study:
- To determine the effectiveness of blood transfusions in reducing mortality among severely anaemic children in a Kenyan hospital.
- To identify specific clinical and laboratory criteria that predict improved survival following transfusion.
- To guide transfusion strategies for better resource utilization and patient outcomes.
Main Methods:
- Prospective data collection on 2433 child admissions over one year in a Kenyan hospital.
- Recording clinical presentation, haemoglobin levels (Hb), transfusion status, and in-hospital survival.
- Statistical analysis using odds ratios to compare mortality between transfused and non-transfused children based on Hb levels and clinical signs.
Main Results:
- 29% of admissions had severe anaemia (Hb < 5.0 g/dl); 20% received transfusions.
- Children with Hb < 3.9 g/dl transfused early (day 0 or 1) had significantly lower mortality.
- Children with Hb < 4.7 g/dl and respiratory distress who received transfusions showed markedly reduced mortality (OR 0.19).
Conclusions:
- Transfusion timing and patient selection are crucial for improving survival in severe paediatric anaemia.
- Targeting transfusions to children with severe anaemia and respiratory distress enhances survival.
- Early transfusion, particularly for those with respiratory distress, can reduce mortality and optimize blood resource allocation.
Abstract:
In Africa, blood transfusions are frequently given to treat severe paediatric anaemia. Because of the risk of HIV transmission, identification of when transfusion will reduce the risk of death for severely anaemic children has become increasingly important. For all children admitted to a Kenyan hospital from October, 1989, to October, 1990, we collected data on clinical presentation, haemoglobin (Hb), receipt of transfusion, and in-hospital survival. Of 2433 admissions, 29% (684) had severe anaemia (Hb less than 5.0 g/dl), and 20% (483) received blood transfusions. Based on laboratory criteria only, children with Hb less than 3.9 g/dl who were transfused had lower mortality than those with Hb less than 3.9 g/dl who were not transfused, but this finding applied only to children transfused on the day of admission (odds ratio [OR] 0.30; 95% Cl 0.14, 0.61) or the day after admission (OR 0.37; 95% Cl 0.14, 1.00). Based on a combination of laboratory and clinical criteria, children with clinical signs of respiratory distress and Hb less than 4.7 g/dl who were transfused had lower morality than those who were not (OR 0.19; 95% Cl 0.09, 0.41). Among children without respiratory distress, there was no association between receipt of transfusion and mortality, irrespective of admission Hb. The frequency of blood transfusion can be reduced and survival enhanced by targeting blood to those children with severe anaemia and clinical signs of respiratory distress, and by using transfusion early in the course of hospitalisation.
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