LONGITUDINAL EVALUATION OF SEVERELY ANEMIC CHILDREN IN KENYA - THE EFFECT OF TRANSFUSION ON MORTALITY AND HEMATOLOGIC RECOVERY

Objective: To determine the effect of transfusion on hematologic recov ery and mortality among severely anemic children during and after hosp italization in rural Kenya. Design: Prospective cohort. Methods: We co llected clinical and laboratory information on all severely anemic chi ldren (hemoglobin < 5.0 g/dl) and a 33% sample of children with hemogl obin greater than or equal to 5.0 g/dl who were admitted to the pediat ric ward of a rural Kenyan hospital during a 6 month study period. Chi ldren were followed during hospitalization and at 4 and 8 weeks after admission. Results: Overall, 303 (25%) of the 1223 hospitalized childr en had hemoglobin < 5.0 g/dl, 30% of whom died during the study period . Severely anemic children who were transfused had a higher mean hemog lobin level at discharge (9.0 g/dl) than non-transfused children (5.8 g/dl, P< 0.001) and maintained a higher mean hemoglobin during the 8-w eek follow-up period. However, the presence of malaria parasitemia on follow-up negated the benefit of transfusion on hematologic recovery a t both 4- and 8-week visits (longitudinal linear model, least square m eans, P> 0.05). Transfusion was associated with improved survival amon g children with respiratory distress who received transfusions within the first 2 days of hospitalization. Conclusions: The use of transfusi on can be improved by targeting use of blood to severely anemic childr en with cardiorespiratory compromise, improving immediate availability of blood, and treating severely anemic children with effective antima larial therapy.