Blood transfusion for treating malarial anaemia

Abstract

Background Blood transfusion is used in patients with severe malarial anaemia, but risks adverse reactions, transmission of disease, and is complicated to organize in developing countries. Objectives This review evaluates the effects of routine blood transfusion for severe anaemia on death and adverse outcomes in malarious areas. Search strategy We searched the Cochrane Infectious Diseases Group Specialized Register (April 2010), CENTRAL (The Cochrane Library Issue 2, 2010), MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), LILACS (April 2010), and reference lists of relevant articles. We contacted researchers and organizations working in the field. Selection criteria Randomized and quasi-randomized trials of blood transfusion compared with conservative management in malaria-associated severe anaemia. Data collection and analysis Trials were identified and data extracted by a single reviewer (MM) and checked by a second (HS). Inclusion criteria were applied and data were extracted independently by both reviewers. Main results Two randomized trials of 230 children were included. In the transfusion group, there was a non-significant tendency towards fewer deaths (RR 0.41, 95% CI 0.06 to 2.70), but a trend towards more severe adverse events (RR 8.60, 95% CI 1.11 to 66.43). In one trial by Bojang (1997a) respiratory distress was less common and hospital stay was shorter in the transfusion group (MD 1.88 days, 95% CI 2.41 to 1.35). Subsequent need for urgent blood transfusion was less common in the transfusion group (RR 0.12, 95% CI 0.02 to 0.68). Day 28 packed cell volume was less in the transfusion group (MD -1.34, 95% CI -2.57 to -0.11). There was no information on HIV or Hepatitis B virus transmission. Authors' conclusions There is insufficient data to be sure whether routinely giving blood to clinically stable children with severe anaemia in endemic malarious areas reduces death, or results in higher haematocrit measured at one month. Plain language summary Malaria may cause anaemia. In areas where malaria is common and transmission is intense, many children are infected with the parasite, and severe anaemia can commonly cause death. Blood transfusions can be important for preventing deaths in very ill patients, although there are also some risks involved. This review was designed to assess the benefits and harms of giving a blood transfusion to all children with severe malarial anaemia but otherwise not in distress or severely unwell. Two studies met our inclusion criteria, with a total of 230 children included in them; no studies looked at adults. There were fewer deaths in children who had blood transfusion compared with those who did not, but the numbers were small and not statistically significant. There was a trend towards more severe adverse events in the transfusion group, but a trend toward shorter hospital stay. The proportion of blood volume made up of red blood cells (haematocrit) was lower in transfused versus non-transfused children at day 28. In conclusion, for a clinician faced with a child with severe anaemia who is otherwise stable and not distressed, there is insufficient evidence to know whether the risks of routine blood transfusion outweigh the benefit. Assessed as up-to-date: 6 APR 2010