Research

Survival and haematological recovery of children with severe malaria transfused in accordance to WHO guidelines in Kilifi, Kenya

Samuel O Akech¹ , Oliver Hassall^1,2 , Allan Pamba¹ , Richard Idro^1,3 , Thomas N Williams^1,4 , Charles RJC Newton^1,5,6 and Kathryn Maitland^1,7

¹  Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, Kenya

²  Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK

³  Department of Paediatrics and Child Health, Mulago Hospital/Makerere University Medical School, Kampala, Uganda

⁴  Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK

⁵  Neurosciences Unit, Institute of Child Health, The Wolfson Centre, Mecklenburgh Square, London, WC1N 2AP, UK

⁶  Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, UK

⁷  Department of Paediatrics and Wellcome Trust Centre for Clinical Tropical Medicine, Faculty of Medicine, Imperial College, Norfolk Plac3e, London, W2 1PG, UK

author email corresponding author email

Malaria Journal 2008, 7:256doi:10.1186/1475-2875-7-256

Published:	16 December 2008

Abstract

Background

Severe anaemia requiring emergency blood transfusion is a common complication of malaria in children. To ensure access for urgent blood transfusion, the World Health Organization has developed clear guidelines with haemoglobin thresholds prevent unwarranted transfusion,. Few studies have reported outcome and haematological recovery of children with severe malaria where transfusion practice complies with WHO recommendations.

Methods

A prospective observational study of survivors of severe and complicated malaria transfused in accordance with WHO guidelines. Children were invited for review at one month post-discharge. Non-attendees were traced in the community to ascertain survival.

Results

Outcome was assessed in 213 survivors. Those transfused were younger, had a higher base deficit, mean lactate levels and a higher prevalence of respiratory distress. As expected mean admission haemoglobin (Hb) was significantly lower amongst transfused [5.0 g/dL SD: 1.9] compared to non-transfused children [8.3 g/dL SD: 1.7] (p < 0.001). At discharge mean Hb was similar 6.4 g/dL [SD: 1.5] and 6.8 g/dL [SD: 1.6] respectively (p = 0.08), most children remained moderately to severely anaemic. At one month follow up 166 children (78%) returned, in whom we found no differences in mean Hb between the transfused (10.2 g/dL [SD: 1.7]) and non-transfused (10.0 g/dL [SD: 1.3]) survivors (p = 0.25). The major factors affecting haematological recovery were young age (<24 months) and concomitant malaria parasitaemia; Hb being 8.8 g/dL [SD: 1.5] in parasitaemic individuals compared with 10.5 g/dL [SD: 1.3] in those without (p < 0.001).

Conclusion

This data supports the policy of rational use of blood transfusion, as proposed in the WHO guidelines, for children with anaemia in areas where access to emergency transfusion is not guaranteed. We have provided empirical data indicating that transfusion does not influence superior recovery in haemoglobin concentrations and therefore cannot be justified on this basis alone. This may help resolve the disparity between international policy and current clinical practice. Effective anti-malarial treatment at discharge may prevent reoccurrence of anaemia.