Global programme on AIDS. A study on the effect of blood transfusion on survival among children in a Kenyan hospital.

A study was conducted among children under 12 years of age admitted to a rural district hospital in western Kenya to evaluate the use of blood transfusions, identify risk factors for severe anemia, and determine when transfusion improves survival of severely anemic children. A total of 2433 children were admitted to the pediatric ward during the 12-month study period; 29% (684) had severe anemia (hemoglobin [Hb] 5.0 g/dl) and 20% (483) received blood transfusions. Among children admitted with Hb 5.0 g/dl, 19% (124/663) had a history of prior transfusion, compared with only 6% (94/1607) with Hb 5.0 g/dl. The fatality rate of all children with Hb 5.0 g/dl was 18%, compared with 8% among children with Hb 5.0 g/dl. Among all children who died during hospitalization, 48% had a Hb 5.0 g/dl at the time of admission. Children younger than 3 years old accounted for 92% of admissions with Hb 5.0 g/dl, 87% of all pediatric deaths, and 92% of all pediatric transfusions. Age under 3 years and malaria parasitemia were associated with severe anemia. 88% (424) of transfusions were given to children with Hb 5.0 g/dl. Only 25% (120) of transfused children received blood on the date of admission, while 34% (161) were transfused the day after admission, and 41% (199) were transfused 2 or more days after admission. Among children with Hb 5.0 g/dl, 40% (274/683) were not transfused. If transfusions had been given only within the first 2 days of admission to children with respiratory distress and Hb 5.0 g/dl, the frequency of transfusion would have been reduced by 55% without increasing mortality. Prevention and effective treatment of the causes of anemia (such as malaria), targeted to children under 3 years of age, are critically needed to limit pediatric anemia, blood transfusion, and anemia-associated mortality.