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  • Title: Anaemia, blood transfusion practices, HIV and mortality among women of reproductive age in western Kenya.
    Author: Zucker JR, Lackritz EM, Ruebush TK, Hightower AW, Adungosi JE, Were JB, Campbell CC.
    Journal: Trans R Soc Trop Med Hyg; 1994; 88(2):173-6. PubMed ID: 8036663.
    Abstract:
    Severe anaemia among women in sub-Saharan Africa is frequently treated with blood transfusions. The risk of transmission of human immunodeficiency virus (HIV) through blood products has led to a re-evaluation of the indications for transfusions. Prospective surveillance of women admitted to a district hospital in western Kenya was conducted from 1 December 1990 to 31 July 1991, for haemoglobin (Hb) transfusion status, and outcome. Of the 2986 enrolled women (mean Hb 10.4 g/dL, SD +/- 2.6, median age 24.4 years), 6% were severely anaemic (Hb < 6.0 g/dL). Severe anaemia was associated with a higher mortality rate (10.7% vs. 1.4%, odds ratio (OR) = 8.2, 95% confidence interval (CI) 2.6, 34.2) compared with women with Hb > or = 6.0 g/dL. Decreased mortality rates in hospital were observed with increasing Hb values (OR = 0.43, 95% CI 0.19, 0.98), but blood transfusions did not improve survival in hospital (OR = 1.56, 95% CI 0.22, 11.03). The attributable mortality due to HIV infection and severe anaemia was 75% and 31%, respectively. Maternal/child health care services must include prevention strategies for HIV transmission and the prevention, recognition, and treatment of severe anaemia. This paper reports the findings of an evaluation of Western Kenyan blood transfusion practices used with a cohort of severely anemic women of child-bearing age. The potential of receiving HIV-infected blood puts these women at a definite health risk. Characteristics of severely anemic women included being older (P = 0.03, Wilcoxon rank sum test), lower likelihood of being pregnant when admitted to hospital (odds ratio [OR] = 0.53; 95% confidence interval [CI], 0.35-0.81), and greater likelihood of being HIV seropositive (OR = 2.92; 95% CI, 1.52-5.60) when compared to non-anemic women. Severely anemic women were also less likely to have malaria (OR = 0.58; 95% CI, 0.35-0.96). Women who had a transfusion ordered had a higher mortality rate than women who did not (25/240, 10.4% vs. 18/933, 1.9%)(OR = 5.91; 95% CI, 3.04-11.53). In this study, positive benefits were restricted to women who had a transfusion only for them. These were the severely anemic women. The attributed mortality caused by HIV infection and severe anemia was 75% and 31%, respectively. Detection of HIV infected blood is very critical. Prevention of anemia is considered more important than transfusing concerns. Preventing the need for transfusions would reduce the HIV transmission risk from potentially infectious blood during transfusion.
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