Severe childhood anemia and emergency blood transfusion in Gadarif Hospital, eastern Sudan


Autoři: Mohammed Ahmed A. Ahmed aff001;  Abdullah Al-Nafeesah aff002;  Osama Al-Wutayd aff003;  Hyder M. Mahgoub aff004;  Ishag Adam aff005
Působiště autorů: Faculty of Medicine, Gadarif University, Gadarif, Sudan aff001;  Department of Paediatrics, Unaizah College of Medicine, Qassim University, Unaizah, Kingdom of Saudi Arabia aff002;  Department of Family and Community Medicine, Unaizah College of Medicine, Qassim University, Unaizah, Kingdom of Saudi Arabia aff003;  New Halfa Hospital, New Halfa, Sudan aff004;  Department of Obstetrics and Gynecology, Unaizah College of Medicine, Qassim University, Unaizah, Kingdom of Saudi Arabia aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225731

Souhrn

Background

Anemia is a major cause of global morbidity and mortality, particularly among children. Management of anemia depends on causes and severity of anemia. However blood transfusion is a lifesaving intervention in severe and life-threatening anemia. There are no published data on blood transfusion for anemia in Sudan.

Methods

A descriptive study was conducted in Gadarif Hospital in eastern Sudan during 1 August, 2017 to 31 March, 2018. Consecutive children who presented at the emergency room with an indication for blood transfusion were enrolled in the study. A detailed history was gathered from all patients. Physical examinations, including vital signs, were performed. The World Health Organization guidelines for blood transfusion were followed.

Results

During the study period, a total of 1800 children were admitted to the emergency pediatric ward in Gadarif Hospital and were assessed for anemia, 513 (28.5%) were anemic and 141 (7.8%) had severe anemia. Three hundred anemic children received blood transfusion. The median (interquartile) of the age of the 300 children who received blood transfusion was 4.2 4.2(2.0–9.0) years. A total of 148 (49.3%) of the children were boys and 151 (50.3%) were younger than 5 years. The diagnoses associated with the order for blood transfusion were sickle cell disease (129, 43.0%), active bleeding (58, 19.3%), malaria (50, 16.7%), visceral leishmaniasis (25, 8.3%), severe acute malnutrition (16, 5.30%), snake bite (11, 3.7%), sepsis (5, 1.7%), and others. Two hundred eighty-five (95.0%) children improved, nine children were discharged against medical advice, and six (2.0%) children died.

Conclusion

There is a high burden of anemia in eastern Sudan. Sickle cell disease, malaria, and visceral leishmaniasis are the main causes of anemia in this region. Further research on blood transfusion is needed.

Klíčová slova:

anémia – Blood transfusion – Hemoglobin – Children – Malaria – Malnutrition – Pediatrics – Sickle cell disease


Zdroje

1. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr. 2009;12: 444–54. doi: 10.1017/S1368980008002401 18498676

2. Kiguli S, Maitland K, George EC, Olupot-Olupot P, Opoka RO, Engoru C, et al. Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness. BMC Med. 2015;13: 21. doi: 10.1186/s12916-014-0246-7 25640706

3. Manning L, Laman M, Rosanas-Urgell A, Michon P, Aipit S, Bona C, et al. Severe anemia in Papua New Guinean children from a malaria-endemic area: a case-control etiologic study. Ozcel MA, editor. PLoS Negl Trop Dis. 2012;6: e1972. doi: 10.1371/journal.pntd.0001972 23272266

4. Malamba S, Hladik W, Reingold A, Banage F, McFarland W, Rutherford G, et al. The effect of HIV on morbidity and mortality in children with severe malarial anaemia. Malar J. 2007;6: 143. doi: 10.1186/1475-2875-6-143 17973997

5. Calis JC, Phiri KS, Faragher EB, Brabin BJ, Bates I, Cuevas LE, et al. Severe anemia in Malawian children. Malawi Med J. 2016;28: 99–107. http://www.ncbi.nlm.nih.gov/pubmed/27895843 27895843

6. Mahgoub H, Gasim GI, Musa IR, Adam I. Severe Plasmodium vivax malaria among sudanese children at New Halfa Hospital, Eastern Sudan. Parasit Vectors. 2012;5: 154. doi: 10.1186/1756-3305-5-154 22846165

7. Mahgoub HM, Mohamed AA, Magzoub M, Gasim GI, Eldein WN, Ahmed AA, et al. Schistosoma mansoni infection as a predictor of severe anaemia in schoolchildren in eastern Sudan. J Helminthol. 2010;84: 132–135. doi: 10.1017/S0022149X09990368 19712536

8. English M, Ahmed M, Ngando C, Berkley J, Ross A. Blood transfusion for severe anaemia in children in a Kenyan hospital. Lancet. 2002;359: 494–495. doi: 10.1016/S0140-6736(02)07666-3 11853798

9. World HO (WHO). The Clinical Use of Blood Handbook World Health Organization Blood Transfusion Safety GENEVA [Internet]. 2001. www.who.int

10. Shari CR, Sawe HR, Murray BL, Mwafongo VG, Mfinanga JA, Runyon MS. Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania. BMC Hematol. 2017;17: 19. doi: 10.1186/s12878-017-0091-y 29152308

11. Thomas J, Ayieko P, Ogero M, Gachau S, Makone B, Nyachiro W, et al. Blood Transfusion Delay and Outcome in County Hospitals in Kenya. Am J Trop Med Hyg. 2017;96: 511–517. doi: 10.4269/ajtmh.16-0735 27920394

12. World HO (WHO). WHO | Pocket book of hospital care for children: Second edition. WHO. World Health Organization; 2017;

13. Ahmed MAA, Ahmed AA, Omar SM, Adam GK, Abdallah TM, Ali AA. Epidemiology of visceral leishmaniasis among children in Gadarif hospital, eastern Sudan. BMC Public Health. 2016;16: 1234. doi: 10.1186/s12889-016-3875-2 27927185

14. Hashim H, Ali E. Pattern of malaria in hospitalized children in Khartoum state. Sudan J Paediatr. 2017;17: 35–41. doi: 10.24911/SJP.2017.2.4 29545663

15. Elsamani MS, Elsaeed AE, Mohamedani AA, Assayed AA. Prevalence of anaemia among Quranic school (Khalawi) students (Heiran)in Wad El Magboul village, rural Rufaa, Gezira State, Central Sudan: a cross sectional study. Pan Afr Med J. 2016;24: 244. doi: 10.11604/pamj.2016.24.244.8355 27800099

16. Opoka RO, Ssemata AS, Oyang W, Nambuya H, John CC, Tumwine JK, et al. High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals. BMC Health Serv Res. 2018;18: 566. doi: 10.1186/s12913-018-3382-5 30021576

17. Nabwera HM, Fegan G, Shavadia J, Denje D, Mandaliya K, Bates I, et al. Pediatric blood transfusion practices at a regional referral hospital in Kenya. Transfusion. 2016;56: 2732–2738. doi: 10.1111/trf.13774 27611471

18. Orish VN, Ilechie A, Combey T, Onyeabor OS, Okorie C, Sanyaolu AO. Evaluation of blood transfusions in anemic children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana. Am J Trop Med Hyg. 2016;94: 691–694. doi: 10.4269/ajtmh.15-0310 26787159

19. Teesdale CH, Amin MA. A simple thick-smear technique for the diagnosis of Schistosoma mansoni infection. Bull World Health Organ. 1976;54: 703–5. http://www.ncbi.nlm.nih.gov/pubmed/1088516 1088516

20. Kahama AI, Odek AE, Kihara RW, Vennervald BJ, Kombe Y, Nkulila T, et al. Urine circulating soluble egg antigen in relation to egg counts, hematuria, and urinary tract pathology before and after treatment in children infected with Schistosoma haematobium in Kenya. Am J Trop Med Hyg. 1999;61: 215–9. doi: 10.4269/ajtmh.1999.61.215 10463669

21. WHO | Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. WHO. World Health Organization; 2018; https://www.who.int/vmnis/indicators/haemoglobin/en/

22. Qureshi B. Book Review: Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. J R Soc Promot Health. 2006;126: 285–285. doi: 10.1177/1466424006070493

23. WHO. WHO child growth standards and the identification of severe acute malnutrition in infants and children. WHO Library. 2009. pp. 1–12.

24. WHO. WHO _ Child malnutrition. In: Global Health Observatory (GHO) data. World Health Organization; 2017.

25. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315: 801–10. doi: 10.1001/jama.2016.0287 26903338

26. Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123: 615–24. doi: 10.1182/blood-2013-06-508325 24297872

27. Muoneke VU, Ibekwe RC, Nebe-Agumadu HU, Ibe BC. Factors associated with mortality in under-five children with severe anemia in Ebonyi, Nigeria. Indian Pediatr. 2012;49: 119–23. http://www.ncbi.nlm.nih.gov/pubmed/21719933 doi: 10.1007/s13312-012-0026-4

28. Himeidan YE, Elzaki MM, Kweka EJ, Ibrahim M, Elhassan IM. Pattern of malaria transmission along the Rahad River basin, Eastern Sudan. Parasit Vectors. 2011;4: 109. doi: 10.1186/1756-3305-4-109 21679459

29. Giha HA, Elghazali G, A-Elgadir TME, A-Elbasit IE, Elbashir MI. Severe malaria in an unstable setting: clinical and laboratory correlates of cerebral malaria and severe malarial anemia and a paradigm for a simplified severity scoring. Eur J Clin Microbiol Infect Dis. 2009;28: 661–665. doi: 10.1007/s10096-008-0665-5 19002725

30. Sabahelzain MM, Hamamy H. The ethnic distribution of sickle cell disease in Sudan. Pan Afr Med J. 2014;18: 13. doi: 10.11604/pamj.2014.18.13.3280 25360197

31. Daak AA, Elsamani E, Ali EH, Mohamed FA, Abdel-Rahman ME, Elderdery AY, et al. Sickle cell disease in western Sudan: genetic epidemiology and predictors of knowledge attitude and practices. Trop Med Int Heal. John Wiley & Sons, Ltd (10.1111); 2016;21: 642–653. doi: 10.1111/tmi.12689 27028397

32. WHO. Sickle cell disease | WHO | Regional Office for Africa [Internet]. [cited 15 May 2019]. https://www.afro.who.int/publications/sickle-cell-disease

33. Emergency Transfusion [Internet]. [cited 17 May 2019]. http://www.calgarylabservices.com/lab-services-guide/transfusion-medicine/ordering-blood-components/emergency-transfusion.aspx

34. Maitland K, Kiguli S, Olupot-Olupot P, Engoru C, Mallewa M, Saramago Goncalves P, et al. Immediate Transfusion in African Children with Uncomplicated Severe Anemia. N Engl J Med. 2019;381: 407–419. doi: 10.1056/NEJMoa1900105 31365799

35. Holzer BR, Egger M, Teuscher T, Koch S, Mboya DM, Smith GD. Childhood anemia in Africa: to transfuse or not transfuse? Acta Trop. 1993;55: 47–51. http://www.ncbi.nlm.nih.gov/pubmed/7903137 doi: 10.1016/0001-706x(93)90047-f

36. Badawi MM, Atif MS, Mustafa YY. Systematic review and meta-analysis of HIV, HBV and HCV infection prevalence in Sudan. Virol J. 2018;15: 148. doi: 10.1186/s12985-018-1060-1 30253805


Článek vyšel v časopise

PLOS One


2019 Číslo 12