Severe Childhood Anaemia and Blood Transfusion in a Nigerian Secondary Level Facility

Outcome of Emergency Blood Transfusion in Children Seen at a Tertiary Children's Hospital in Freetown: A Descriptive Cross-sectional Study

OBJECTIVE

This study sought to describe the prevalence and clinical outcome after emergency blood transfusion among children presenting with severe anemia in a tertiary children's hospital in Sierra Leone.

METHOD

This was a retrospective study of 395 children who received emergency blood transfusion at the Ola During Children's Hospital in Freetown. Association between mortality and sociodemographic and clinical factors was assessed using χ 2 test. Statistical significance was set at P < 0.05.

RESULTS

Three hundred ninety-five of 4719 children (8.4%) admitted to the emergency room of the Ola During Children's Hospital received emergency blood transfusion within 24 hours of presentation. Twenty-five (6.3%) were excluded because of incomplete data. The median age of the subjects was 24 months (interquartile range, 14-48). There were 191 boys (51.6%) and 179 girls (48.4%), giving a male/female ratio of 1.06:1. The most common indication for emergency transfusion was severe malaria anemia (67.8%). The mean hemoglobin concentration before transfusion was 4.8 g/dL (±1.4 g/dL). A total of 339 children (91.6%) were discharged home, 8 (2.2%) were discharged against medical advice, and 23 children (6.2%) died. The median length of stay on admission was 3 days (interquartile range, 2-5). Children with severe sepsis ( P < 0.001) and those with pretransfusion hemoglobin concentration less than 5% ( P = 0.047) were significantly more likely to die after transfusion compared with the other categories of patients. In a multivariate regression analysis, none of the factors were independently associated with clinical outcome after blood transfusion in children who received emergency blood transfusion.

CONCLUSION

The study suggests that emergency blood transfusion in children with severe anemia may improve in-hospital survival.

Age-specific malaria vulnerability and transmission reservoir among children

Purpose

The pediatric population, especially under-five children, is highly susceptible to malaria and accounts for 76 % of global malaria deaths according to the World Malaria Report 2022. The purpose of this manuscript is to discuss the various factors involved in the susceptibility of the pediatric population to Malaria and the importance of this age group for malaria elimination.

Methodology

Data on pediatric malaria epidemiology that includes prevalence, risk factors, immune factors, socioeconomic factors, control methods, etc. were extracted from published literature using PubMed and Google Scholar. This data was further correlated with malaria incidence data from the World Health Organization (WHO) and the National Center for Vector Borne Diseases Control (NCVBDC).

Results

The younger age group is vulnerable to severe malaria due to an immature immune system. The risk of infection and clinical disease increases after the waning of maternal immunity. In the initial years of life, the developing brain is more susceptible to malaria infection and its after-effects. The pediatric population may act as a malaria transmission reservoir due to parasite density and asymptomatic infections. WHO recommended RTS,S/AS01 has limitations and may not be applicable in all settings to propel malaria elimination.

Conclusion

The diagnosis of malaria is based on clinical suspicion and confirmed with microscopy and/or rapid diagnostic testing. The school-age pediatric population serves as a transmission reservoir in the form of asymptomatic malaria since they have acquired some immunity due to exposure in early childhood. Targeting the hidden reservoir in the pediatric population and protecting this vulnerable group will be essential for malaria elimination from the countries targeting elimination.

Reduction in seroprevalence of viral transfusion-transmitted infections in southwest Nigeria in children with sickle cell disease using an enhanced screening strategy

Blood transfusion is an integral component in the management of children and adults with sickle cell disease (SCD). Concerns about blood safety due to the high risk of bloodborne infections in sub-Saharan Africa limits the application of this cost-effective strategy in the management of individuals with SCD. In a single-centre, retrospective, longitudinal study in southwest Nigeria, we hypothesised that the use of stringent blood donor selection, along with very sensitive enzyme-linked immunosorbent assay (ELISA) screening methods would reduce transfusion-transmitted infections (TTIs). Among 45 002 eligible blood donors at the Lagos University Teaching Hospital in Nigeria, over a 5-year review period (2015-2019), the seroprevalence rate of viral TTIs was 9.83%. The seroprevalence rates for human immunodeficiency, hepatitis B, and hepatitis C viruses were 1.37%, 6.2%, and 2.25% respectively. Among 172 children with SCD, 71% (122/172) on regular blood transfusion and 29% (50/172) who had never been transfused or had less than two transfusions per lifetime, none acquired any TTIs using our enhanced screening approach during the study period. Thus, safe blood transfusion practices can be provided for children with SCD in sub-Saharan Africa with the use of stringent donor selection protocols and fourth-generation ELISA kits for TTI screening.

Transfusional malaria in the neonatal period in Lagos, South-West Nigeria

Background and objectives

Sick neonates in malaria endemic areas are frequently transfused with donor blood unscreened for malaria parasite. Consequently, they are at risk of transfusional malaria which can lead to increased neonatal mortality. The study aimed to determine the burden of transfusional malaria in neonates to help in policy formulation on prevention of transfusional malaria.

Materials and methods

One hundred and sixty four neonates admitted into the neonatal unit of a tertiary hospital over a 10 month period who were scheduled for blood transfusion were screened for malaria parasites pre-transfusion, at three and 14 days post transfusion using Giemsa stained thick and thin films. Donor blood was screened for malaria parasites at the point of transfusion. Neonates who developed malaria parasitaemia post transfusion were followed up for signs of malaria.

Results

All recruited neonates tested negative to malaria parasite pre- transfusion. One hundred and twenty (73.2%) were term neonates with 94(57.3%) aged 1-7days. Four (2.4%) neonates developed malaria parasitaemia three days post transfusion and all four developed fever that resolved on treatment for malaria. Three (1.8%) of 164 donor blood samples had malaria parasitaemia and all three (100%) neonates who were transfused with the infected donor blood developed malaria parasitaemia post transfusion. However, one neonate who developed malaria parasitaemia post transfusion was transfused with non-infected donor blood.

Conclusions

The prevalence of transfusional malaria in this study is low (2.4%). However, 100% of neonates who received malaria infected donor blood developed transfusional malaria. We therefore recommend routine screening of donor pre-transfusion, testing of neonates who develop fever post transfusion and treatment of those who test positive to malaria.