title: Severe anaemia associated with Plasmodium falciparum infection in children: consequences for additional blood sampling for research.
abstract: Plasmodium falciparum infection may cause severe anaemia, particularly in children. When planning a diagnostic study on children suspected of severe malaria in sub-Saharan Africa, it was questioned how much blood could be safely sampled; intended blood volumes (blood cultures and EDTA blood) were 6 mL (children aged <6 years) and 10 mL (6-12 years). A previous review [Bull World Health Organ. 89: 46-53. 2011] recommended not to exceed 3.8 % of total blood volume (TBV). In a simulation exercise using data of children previously enrolled in a study about severe malaria and bacteraemia in Burkina Faso, the impact of this 3.8 % safety guideline was evaluated.
  
  
  
  For a total of 666 children aged >2 months to <12 years, data of age, weight and haemoglobin value (Hb) were available. For each child, the estimated TBV (TBVe) (mL) was calculated by multiplying the body weight (kg) by the factor 80 (ml/kg). Next, TBVe was corrected for the degree of anaemia to obtain the functional TBV (TBVf). The correction factor consisted of the rate 'Hb of the child divided by the reference Hb'; both the lowest ('best case') and highest ('worst case') reference Hb values were used. Next, the exact volume that a 3.8 % proportion of this TBVf would present was calculated and this volume was compared to the blood volumes that were intended to be sampled.
  
  
  
  When applied to the Burkina Faso cohort, the simulation exercise pointed out that in 5.3 % (best case) and 11.4 % (worst case) of children the blood volume intended to be sampled would exceed the volume as defined by the 3.8 % safety guideline. Highest proportions would be in the age groups 2-6 months (19.0 %; worst scenario) and 6 months-2 years (15.7 %; worst case scenario). A positive rapid diagnostic test for P. falciparum was associated with an increased risk of violating the safety guideline in the worst case scenario (p = 0.016).
  
  
  
  Blood sampling in children for research in P. falciparum endemic settings may easily violate the proposed safety guideline when applied to TBVf. Ethical committees and researchers should be wary of this and take appropriate precautions.
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. lkuijpers@itg.be.|Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium. lkuijpers@itg.be.
authors.forename: Laura Maria Francisca
authors.initials: LM
authors.lastname: Kuijpers
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.|Centre for Molecular and Vascular Biology, Leuven, Belgium.
authors.forename: Jessica
authors.initials: J
authors.lastname: Maltha
authors.affiliation: Institut de Recherche En Sciences de La Santé (IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Issa
authors.initials: I
authors.lastname: Guiraud
authors.affiliation: Institut de Recherche En Sciences de La Santé (IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Bérenger
authors.initials: B
authors.lastname: Kaboré
authors.affiliation: Institut de Recherche En Sciences de La Santé (IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Palpouguini
authors.initials: P
authors.lastname: Lompo
authors.affiliation: Paediatrics, University Hospital Leuven, Leuven, Belgium.
authors.forename: Hugo
authors.initials: H
authors.lastname: Devlieger
authors.affiliation: Centre for Molecular and Vascular Biology, Leuven, Belgium.|Paediatrics, University Hospital Leuven, Leuven, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Van Geet
authors.affiliation: Institut de Recherche En Sciences de La Santé (IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.|Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Jacobs
mesh_terms: D000740:Anemia / Q000175:diagnosis*; D035843:Biomedical Research / Q000379:methods*; D002050:Burkina Faso; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D013048:Specimen Handling / Q000379:methods*
keywords: Blood specimen collection; Blood volume; Child; Practice guidelines as topic