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 unwell.
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 the benefit.