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Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness

BACKGROUND: Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. METHODS: We present data from a large controlled trial of fluid resuscitation (Flu...

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Autores principales: Kiguli, Sarah, Maitland, Kathryn, George, Elizabeth C, Olupot-Olupot, Peter, Opoka, Robert O, Engoru, Charles, Akech, Samuel O, Nyeko, Richard, Mtove, George, Reyburn, Hugh, Levin, Michael, Babiker, Abdel G, Gibb, Diana M, Crawley, Jane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313469/
https://www.ncbi.nlm.nih.gov/pubmed/25640706
http://dx.doi.org/10.1186/s12916-014-0246-7
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author Kiguli, Sarah
Maitland, Kathryn
George, Elizabeth C
Olupot-Olupot, Peter
Opoka, Robert O
Engoru, Charles
Akech, Samuel O
Nyeko, Richard
Mtove, George
Reyburn, Hugh
Levin, Michael
Babiker, Abdel G
Gibb, Diana M
Crawley, Jane
author_facet Kiguli, Sarah
Maitland, Kathryn
George, Elizabeth C
Olupot-Olupot, Peter
Opoka, Robert O
Engoru, Charles
Akech, Samuel O
Nyeko, Richard
Mtove, George
Reyburn, Hugh
Levin, Michael
Babiker, Abdel G
Gibb, Diana M
Crawley, Jane
author_sort Kiguli, Sarah
collection PubMed
description BACKGROUND: Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. METHODS: We present data from a large controlled trial of fluid resuscitation (Fluid Expansion As Supportive Therapy (FEAST) trial) on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness (predominantly malaria and/or sepsis) and impaired peripheral perfusion. RESULTS: Of 3,170 children in the FEAST trial, 3,082 (97%) had baseline haemoglobin (Hb) measurement, 2,346/3,082 (76%) were anaemic (Hb <10 g/dL), and 33% severely anaemic (Hb <5 g/dL). Prevalence of severe anaemia varied from 12% in Kenya to 41% in eastern Uganda. 1,387/3,082 (45%) children were transfused (81% within 8 hours). Adherence to WHO transfusion guidelines was poor. Among severely anaemic children who were not transfused, 52% (54/103) died within 8 hours, and 90% of these deaths occurred within 2.5 hours of randomisation. By 24 hours, 128/1,002 (13%) severely anaemic children had died, compared to 36/501 (7%) and 71/843 (8%) of those with moderate and mild anaemia, respectively. Among children without severe hypotension who were randomised to receive fluid boluses of 0.9% saline or albumin, mortality was increased (10.6% and 10.5%, respectively) compared to controls (7.2%), regardless of admission Hb level. Repeat transfusion varied from ≤2% in Kenya/Tanzania to 6 to 13% at the four Ugandan centres. Adverse reactions to blood were rare (0.4%). CONCLUSIONS: Severe anaemia complicates one third of childhood admissions with serious febrile illness to hospitals in East Africa, and is associated with increased mortality. A high proportion of deaths occurred within 2.5 hours of admission, emphasizing the need for rapid recognition and prompt blood transfusion. Adherence to current WHO transfusion guidelines was poor. The high rates of re-transfusion suggest that 20 mL/kg whole blood or 10 mL/kg packed cells may undertreat a significant proportion of anaemic children. Future evaluation of the impact of a larger volume of transfused blood and optimum transfusion management of children with Hb of <6 g/dL is warranted. Please see related article: http://dx.doi.org/10.1186/s12916-014-0248-5. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-014-0246-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-43134692015-02-03 Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness Kiguli, Sarah Maitland, Kathryn George, Elizabeth C Olupot-Olupot, Peter Opoka, Robert O Engoru, Charles Akech, Samuel O Nyeko, Richard Mtove, George Reyburn, Hugh Levin, Michael Babiker, Abdel G Gibb, Diana M Crawley, Jane BMC Med Research Article BACKGROUND: Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. METHODS: We present data from a large controlled trial of fluid resuscitation (Fluid Expansion As Supportive Therapy (FEAST) trial) on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness (predominantly malaria and/or sepsis) and impaired peripheral perfusion. RESULTS: Of 3,170 children in the FEAST trial, 3,082 (97%) had baseline haemoglobin (Hb) measurement, 2,346/3,082 (76%) were anaemic (Hb <10 g/dL), and 33% severely anaemic (Hb <5 g/dL). Prevalence of severe anaemia varied from 12% in Kenya to 41% in eastern Uganda. 1,387/3,082 (45%) children were transfused (81% within 8 hours). Adherence to WHO transfusion guidelines was poor. Among severely anaemic children who were not transfused, 52% (54/103) died within 8 hours, and 90% of these deaths occurred within 2.5 hours of randomisation. By 24 hours, 128/1,002 (13%) severely anaemic children had died, compared to 36/501 (7%) and 71/843 (8%) of those with moderate and mild anaemia, respectively. Among children without severe hypotension who were randomised to receive fluid boluses of 0.9% saline or albumin, mortality was increased (10.6% and 10.5%, respectively) compared to controls (7.2%), regardless of admission Hb level. Repeat transfusion varied from ≤2% in Kenya/Tanzania to 6 to 13% at the four Ugandan centres. Adverse reactions to blood were rare (0.4%). CONCLUSIONS: Severe anaemia complicates one third of childhood admissions with serious febrile illness to hospitals in East Africa, and is associated with increased mortality. A high proportion of deaths occurred within 2.5 hours of admission, emphasizing the need for rapid recognition and prompt blood transfusion. Adherence to current WHO transfusion guidelines was poor. The high rates of re-transfusion suggest that 20 mL/kg whole blood or 10 mL/kg packed cells may undertreat a significant proportion of anaemic children. Future evaluation of the impact of a larger volume of transfused blood and optimum transfusion management of children with Hb of <6 g/dL is warranted. Please see related article: http://dx.doi.org/10.1186/s12916-014-0248-5. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-014-0246-7) contains supplementary material, which is available to authorized users. BioMed Central 2015-02-02 /pmc/articles/PMC4313469/ /pubmed/25640706 http://dx.doi.org/10.1186/s12916-014-0246-7 Text en © Kiguli et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kiguli, Sarah
Maitland, Kathryn
George, Elizabeth C
Olupot-Olupot, Peter
Opoka, Robert O
Engoru, Charles
Akech, Samuel O
Nyeko, Richard
Mtove, George
Reyburn, Hugh
Levin, Michael
Babiker, Abdel G
Gibb, Diana M
Crawley, Jane
Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness
title Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness
title_full Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness
title_fullStr Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness
title_full_unstemmed Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness
title_short Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness
title_sort anaemia and blood transfusion in african children presenting to hospital with severe febrile illness
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313469/
https://www.ncbi.nlm.nih.gov/pubmed/25640706
http://dx.doi.org/10.1186/s12916-014-0246-7
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