Childhood anemia in Africa: to transfuse or not transfuse?
Blood transfusions are an important route for HIV transmission in Africa. To explore whether transfusions are necessary in the case management of childhood anemia, a randomized trial was performed in Ifakara, Tanzania, a holoendemic malaria region. 116 children were randomized to receive either treatment for malaria and hookworm alone or, in addition, a transfusion of whole blood which had been tested negative for antibodies against the human immunodeficiency virus. Mean packed cell volume (PCV) at admission was 14.0% in the transfusion and 14.4% in the no transfusion group. Children were followed up for 8 weeks with measurements of PCV at 2 days, 4 weeks and 8 weeks after study entry. PCV was similar in both groups after 4 and 8 weeks (22.9% in the transfusion and 23.6% in the no transfusion group). There was a trend towards more hospital admissions and deaths in the no transfusion group; however, 95% confidence intervals included both a beneficial and an adverse effect of blood transfusions. The costs and benefits of transfusion for childhood anemia in countries with a high HIV prevalence need to be considered carefully before a rational treatment policy can be adopted. For that purpose, a larger randomized trial is urgently needed.
Holzer
B R
BR
St. Francis Designated District Hospital, Ifakara, Kilombero, Tanzania.
Egger
M
M
Teuscher
T
T
Koch
S
S
Mboya
D M
DM
Smith
G D
GD
D000740:Anemia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use; D015658:HIV Infections / Q000635:transmission; D006400:Hematocrit; D006725:Hookworm Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000188:drug therapy; D008463:Mebendazole / Q000627:therapeutic use; D012307:Risk Factors; D013636:Tanzania; D065227:Transfusion Reaction
D008463:Mebendazole; D002738:Chloroquine