Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness.
Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness.
复制标题
DOI：
10.1186/s12916-014-0246-7
复制
发表时间：
2015-02-02
期刊：
影响因子：
9.3
通讯作者：
Crawley J
中科院分区：
文献类型：
--
作者：
Kiguli S;Maitland K;George EC;Olupot-Olupot P;Opoka RO;Engoru C;Akech SO;Nyeko R;Mtove G;Reyburn H;Levin M;Babiker AG;Gibb DM;Crawley J
在撒哈拉以南非洲，儿童严重贫血是入院的主要原因，也是死亡的主要原因，但关于这一弱势群体输血的公开数据有限。我们介绍了一项液体复苏(液体扩张作为支持疗法(FEAST)试验)大型对照试验的数据，该试验研究了三个东非国家严重发热性疾病(主要是疟疾和/或败血症)和外周血液灌流受损的儿童贫血的患病率、临床特征和输血管理。在FEAST试验的3170名儿童中，3,082名(97%)进行了基线血红蛋白(Hb)测量，2,346/3,082名(76%)患有贫血(Hb<；10g/dl)，33%的儿童患有严重贫血(Hb<；5g/dL)。严重贫血的患病率从肯尼亚的12%到乌干达东部的41%不等。1,387/3,082名儿童(45%)接受了输血(81%在8小时内)。遵守世卫组织输血指南的情况很差。在未输血的严重贫血儿童中，52%(54/103)的儿童在8小时内死亡，其中90%的死亡发生在随机分组的2.5小时内。到24小时，1,002名重度贫血儿童中有128名(13%)死亡，而中度和轻度贫血儿童中分别有36/501名(7%)和71/843名(8%)死亡。在没有严重低血压的儿童中，无论入院时的Hb水平如何，随机接受0.9%生理盐水或白蛋白液体丸的儿童死亡率(分别为10.6%和10.5%)高于对照组(7.2%)。重复输血在肯尼亚/坦桑尼亚的≤为2%，在乌干达的四个中心为6%至13%。血液不良反应较少(0.4%)。在东非，严重贫血使三分之一患有严重发烧疾病的儿童住院病例复杂化，并与死亡率增加有关。很高比例的死亡发生在入院后2.5个小时内，强调了快速识别和及时输血的必要性。遵守世卫组织现行输血指南的情况很差。高回输率表明，20亿毫升/公斤全血或1000万毫升/公斤红细胞可能对相当大比例的贫血儿童治疗不足。未来有必要对更大输血量的影响进行评估，并对Hb为6微克/分升的儿童进行最佳输血管理。请参阅相关文章：http://dx.doi.org/10.1186/s12916-014-0248-5.本文的在线版本(doi：10.1186/s12916-0140246-7)包含补充材料，授权用户可以使用。
Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. We present data from a large controlled trial of fluid resuscitation (Fluid Expansion As Supportive Therapy (FEAST) trial) on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness (predominantly malaria and/or sepsis) and impaired peripheral perfusion. Of 3,170 children in the FEAST trial, 3,082 (97%) had baseline haemoglobin (Hb) measurement, 2,346/3,082 (76%) were anaemic (Hb <10 g/dL), and 33% severely anaemic (Hb <5 g/dL). Prevalence of severe anaemia varied from 12% in Kenya to 41% in eastern Uganda. 1,387/3,082 (45%) children were transfused (81% within 8 hours). Adherence to WHO transfusion guidelines was poor. Among severely anaemic children who were not transfused, 52% (54/103) died within 8 hours, and 90% of these deaths occurred within 2.5 hours of randomisation. By 24 hours, 128/1,002 (13%) severely anaemic children had died, compared to 36/501 (7%) and 71/843 (8%) of those with moderate and mild anaemia, respectively. Among children without severe hypotension who were randomised to receive fluid boluses of 0.9% saline or albumin, mortality was increased (10.6% and 10.5%, respectively) compared to controls (7.2%), regardless of admission Hb level. Repeat transfusion varied from ≤2% in Kenya/Tanzania to 6 to 13% at the four Ugandan centres. Adverse reactions to blood were rare (0.4%). Severe anaemia complicates one third of childhood admissions with serious febrile illness to hospitals in East Africa, and is associated with increased mortality. A high proportion of deaths occurred within 2.5 hours of admission, emphasizing the need for rapid recognition and prompt blood transfusion. Adherence to current WHO transfusion guidelines was poor. The high rates of re-transfusion suggest that 20 mL/kg whole blood or 10 mL/kg packed cells may undertreat a significant proportion of anaemic children. Future evaluation of the impact of a larger volume of transfused blood and optimum transfusion management of children with Hb of <6 g/dL is warranted. Please see related article: http://dx.doi.org/10.1186/s12916-014-0248-5. The online version of this article (doi:10.1186/s12916-014-0246-7) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
5.1
作者：
Evans, Jennifer A.;May, Juergen;Horstmann, Rolf D.
通讯作者：
Horstmann, Rolf D.
影响因子：
158.5
作者：
Calis, Job C. J.;Phiri, Kamija S.;van Hensbroek, Michael Boele
通讯作者：
van Hensbroek, Michael Boele
影响因子：
158.5
作者：
Maitland, Kathryn;Kiguli, Sarah;Gibb, Diana M.
通讯作者：
Gibb, Diana M.
影响因子：
168.9
作者：
LACKRITZ, EM;CAMPBELL, CC;WERE, JBO
通讯作者：
WERE, JBO
影响因子：
3
作者：
Gething PW;Patil AP;Smith DL;Guerra CA;Elyazar IR;Johnston GL;Tatem AJ;Hay SI
通讯作者：
Hay SI