Whole Blood Transfusion for Severe Malarial Anemia in a High Plasmodium falciparum Transmission Setting.

Autor:	Ippolito MM; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Kabuya JB; Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia., Hauser M; Faculty of Medicine, University of Basel, Basel, Switzerland.; Children's Research Center, University Children's Hospital, Zurich, Switzerland., Kamavu LK; Saint Paul's General Hospital, Nchelenge, Luapula Province, Zambia., Banda PM; Saint Paul's General Hospital, Nchelenge, Luapula Province, Zambia., Yanek LR; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Malik R; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Mulenga M; Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia., Bailey JA; Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA., Chongwe G; Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia., Louis TA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Shapiro TA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Moss WJ; The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2022 Nov 30; Vol. 75 (11), pp. 1893-1902.
DOI:	10.1093/cid/ciac304
Abstrakt:	Background: Severe malaria resulting from Plasmodium falciparum infection is the leading parasitic cause of death in children worldwide, and severe malarial anemia (SMA) is the most common clinical presentation. The evidence in support of current blood transfusion guidelines for patients with SMA is limited. Methods: We conducted a retrospective cohort study of 911 hospitalized children with SMA in a holoendemic region of Zambia to examine the association of whole blood transfusion with in-hospital survival. Data were analyzed in adjusted logistic regression models using multiple imputation for missing data. Results: The median age of patients was 24 months (interquartile range, 16-30) and overall case fatality was 16%. Blood transfusion was associated with 35% reduced odds of death in children with SMA (odds ratio, 0.65; 95% confidence interval, .52-.81; P = .0002) corresponding to a number-needed-to-treat (NNT) of 14 patients. Children with SMA complicated by thrombocytopenia were more likely to benefit from transfusion than those without thrombocytopenia (NNT = 5). Longer storage time of whole blood was negatively associated with survival and with the posttransfusion rise in the platelet count but was not associated with the posttransfusion change in hemoglobin concentration. Conclusions: Whole blood given to pediatric patients with SMA was associated with improved survival, mainly among those with thrombocytopenia who received whole blood stored for <4 weeks. These findings point to a potential use for incorporating thrombocytopenia into clinical decision making and management of severe malaria, which can be further assessed in prospective studies, and underline the importance of maintaining reliable blood donation networks in areas of high malaria transmission. Competing Interests: Potential conflicts of interest . W. J. M. reports grants or contracts outside the scope of this work, all paid to Johns Hopkins University, from the National Institutes of Health, Bill & Melinda Gates Foundation, and Gavi, the Vaccine Alliance. T. A. L. reports book royalties from Taylor and Francis; consulting fees from the University of Massachusetts (payment to author for educational program review), the University of Minnesota (payment to author for educational program advisory board), and Annual Reviews (payment to author for editorial board); payment for expert testimony on Urban League et al. v Ross et al. (2020 Census issues) from the NYU Brennan Center; and participation on the NIDDK DSMB. T. A. S. reports grants or contracts outside the scope of this work from the National Institutes of Health and Unitaid, both paid to the institution, and Johns Hopkins Malaria Research Institute, paid within institution; multiple United States and international patents for antimalarial drug development (inventions and therapies unrelated to this manuscript); and stock or stock options (multiple in retirement accounts, managed stocks; none directly in pharmaceuticals and none in any way related to work in this manuscript). J. B. K. reports support for attending meetings and travel from the Science of Malaria Eradication in Barcelona. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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