Blood transfusion is used in patients with severe malarial anaemia, but
risks adverse reactions, transmission of disease, and is complicated to
organize in developing countries.
This review evaluates the effects of routine blood transfusion for
severe anaemia on death and adverse outcomes in malarious areas.
We searched the Cochrane Infectious Diseases Group Specialized Register
(April 2010), CENTRAL (The Cochrane Library Issue 2, 2010), MEDLINE
(1966 to April 2010), EMBASE (1980 to April 2010), LILACS (April 2010),
and reference lists of relevant articles. We contacted researchers and
organizations working in the field.
Randomized and quasi-randomized trials of blood transfusion compared
with conservative management in malaria-associated severe anaemia.
Data collection and analysis
Trials were identified and data extracted by a single reviewer (MM) and
checked by a second (HS). Inclusion criteria were applied and data were
extracted independently by both reviewers.
Two randomized trials of 230 children were included. In the transfusion
group, there was a non-significant tendency towards fewer deaths (RR
0.41, 95% CI 0.06 to 2.70), but a trend towards more severe adverse
events (RR 8.60, 95% CI 1.11 to 66.43). In one trial by Bojang (1997a)
respiratory distress was less common and hospital stay was shorter in
the transfusion group (MD 1.88 days, 95% CI 2.41 to 1.35). Subsequent
need for urgent blood transfusion was less common in the transfusion
group (RR 0.12, 95% CI 0.02 to 0.68). Day 28 packed cell volume was less
in the transfusion group (MD -1.34, 95% CI -2.57 to -0.11). There was no
information on HIV or Hepatitis B virus transmission.
There is insufficient data to be sure whether routinely giving blood to
clinically stable children with severe anaemia in endemic malarious
areas reduces death, or results in higher haematocrit measured at one
Plain language summary
Malaria may cause anaemia. In areas where malaria is common and
transmission is intense, many children are infected with the parasite,
and severe anaemia can commonly cause death. Blood transfusions can be
important for preventing deaths in very ill patients, although there are
also some risks involved. This review was designed to assess the
benefits and harms of giving a blood transfusion to all children with
severe malarial anaemia but otherwise not in distress or severely
Two studies met our inclusion criteria, with a total of 230 children
included in them; no studies looked at adults. There were fewer deaths
in children who had blood transfusion compared with those who did not,
but the numbers were small and not statistically significant. There was
a trend towards more severe adverse events in the transfusion group, but
a trend toward shorter hospital stay. The proportion of blood volume
made up of red blood cells (haematocrit) was lower in transfused versus
non-transfused children at day 28.
In conclusion, for a clinician faced with a child with severe anaemia
who is otherwise stable and not distressed, there is insufficient
evidence to know whether the risks of routine blood transfusion outweigh
Assessed as up-to-date: 6 APR 2010
Meremikwu, M. M.; Smith, H. J. Blood transfusion for treating malarial anaemia. Cochrane Database of Systematic Reviews (1999) (Issue 4) Art. No.: CD001475. [DOI: 10.1002/14651858.CD001475]
Blood transfusion for treating malarial anaemia