Effect of blood transfusion on survival among children in a Kenyan hospital
Lackritz, E.M.; Campbell, C.C.; Ruebush, T.K.; Hightower, A.W.; Wakube, W.; Steketee, R.W.; Were, J.B.
Lancet 340(8818): 524-528
1992
ISSN/ISBN: 0140-6736 PMID: 1354285 DOI: 10.1016/0140-6736(92)91719-oDocument Number: 321438
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.