One aspect of the report of Obonyo and others that raises questions about blood transfusion practices in sub-Saharan Africa is the increased mortality among the severely anemic children, even though they were transfused.1 At severe levels of anemia, it is important to titrate very carefully how much blood volume one adds to a failing circulation. Availability of packed red blood cells could reduce the volume of blood one has to transfuse from 20 to 10 mL/kg body weight and that could have made all the difference. Obonyo and others have not stated what blood product was used to correct anemia in these sick children. Also, time is of the essence in a failing heart. The poor blood transfusion services in many developing countries in Africa raises concerns about what targets should be set in relation to health system operations and improvements in the 21st century.
Blood and blood products are very important in medical practice and even more so in tropical medicine and child health. With anemia accounting for > 50% of the annual childhood malaria mortality in Africa, success with the battle may lie in the blood transfusion services.2 If facilities are available to institute and maintain a viable blood transfusion service, with capabilities to separate blood components and store them for appropriate use, there may be improved outcome for some of the major complications of malaria such as severe anemia and disseminated intravascular coagulopathy.
Obonyo CO, Vulule J, Akhwale WS, Grobbee DE, 2007. Inhospital morbidity and mortality due to severe malarial anemia in western Kenya. Am J Trop Med Hyg 77 (6 Suppl):23–28.