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  • Title: Effect of blood transfusion on survival among children in a Kenyan hospital.
    Author: Lackritz EM, Campbell CC, Ruebush TK, Hightower AW, Wakube W, Steketee RW, Were JB.
    Journal: Lancet; 1992 Aug 29; 340(8818):524-8. PubMed ID: 1354285.
    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. Between October 1989-October 1990, health workers collected data on clinical presentation, receipt of transfusion, inhospital survival, and a capillary blood sample from 2433 12-year old children (median age=10 months) admitted to the pediatric ward of the Siaya District Hospital in rural western Kenya to determine when transfusion influences survival of children in the hospital. 29% of the children had severe anemia (Hb5 g/dl). Health workers administered blood transfusions to 20% of all children. Children with severe anemia were more likely to die than those who did not have severe anemia (18% vs. 8%; p.0001). Blood transfusion was associated with decreased mortality only if health workers administered blood transfusions to children with Hb3.9 g.dl during the day of admission (odds ratio [OR]=0.3) or the 1st day after admission (OR=0.37). Yet 41% of children needing a blood transfusion did not receive it until 2 days after admission. This exposed them to the risks of blood especially HIV infection when their chance of receiving any benefit was limited. Children with severe anemia and respiratory distress were also more likely to die than severely anemic children without respiratory distress (p.001). Children with Hb4.7 g/dl and respiratory distress who had received a blood transfusion had a lower mortality rate than those who did not receive a blood transfusion (OR=0.19). No association existed between children who showed no signs of respiratory distress regardless of Hb status and blood transfusion and mortality. Thus health workers at this hospital could improve child survival an reduce the frequency of blood transfusion by giving blood to children with severe anemia and clinical signs of respiratory distress during the day of or the 1st day after admission.
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