CHILDHOOD ANEMIA IN AFRICA - TO TRANSFUSE OR NOT TRANSFUSE

Blood transfusions are an important route for HIV transmission in Afri ca. To explore whether transfusions are necessary in the case manageme nt of childhood anemia, a randomized trial was performed in Ifakara, T anzania, a holoendemic malaria region. 116 children were randomized to receive either treatment for malaria and hookworm alone or, in additi on, a transfusion of whole blood which had been tested negative for an tibodies against the human immunodeficiency virus. Mean packed cell vo lume (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 measu rements of PCV at 2 days, 4 weeks and 8 weeks after study entry. PCV w as similar in both groups after 4 and 8 weeks (22.9% in the transfusio n and 23.6% in the no transfusion group). There was a trend towards mo re hospital admissions and deaths in the no transfusion group; however , 95% confidence intervals included both a beneficial and an adverse e ffect of blood transfusions. The costs and benefits of transfusion for childhood anemia in countries with a high HIV prevalence need to be c onsidered carefully before a rational treatment policy can be adopted. For that purpose, a larger randomized trial is urgently needed.