Zucker J R, Lackritz E M, Ruebush T K, Hightower A W, Adungosi J E, Were J B, Campbell C C
Malaria Branch, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA 30333.
Trans R Soc Trop Med Hyg. 1994 Mar-Apr;88(2):173-6. doi: 10.1016/0035-9203(94)90283-6.
Severe anaemia among women in sub-Saharan Africa is frequently treated with blood transfusions. The risk of transmission of human immunodeficiency virus (HIV) through blood products has led to a re-evaluation of the indications for transfusions. Prospective surveillance of women admitted to a district hospital in western Kenya was conducted from 1 December 1990 to 31 July 1991, for haemoglobin (Hb) transfusion status, and outcome. Of the 2986 enrolled women (mean Hb 10.4 g/dL, SD +/- 2.6, median age 24.4 years), 6% were severely anaemic (Hb < 6.0 g/dL). Severe anaemia was associated with a higher mortality rate (10.7% vs. 1.4%, odds ratio (OR) = 8.2, 95% confidence interval (CI) 2.6, 34.2) compared with women with Hb > or = 6.0 g/dL. Decreased mortality rates in hospital were observed with increasing Hb values (OR = 0.43, 95% CI 0.19, 0.98), but blood transfusions did not improve survival in hospital (OR = 1.56, 95% CI 0.22, 11.03). The attributable mortality due to HIV infection and severe anaemia was 75% and 31%, respectively. Maternal/child health care services must include prevention strategies for HIV transmission and the prevention, recognition, and treatment of severe anaemia.
撒哈拉以南非洲地区的女性严重贫血常常通过输血来治疗。通过血液制品传播人类免疫缺陷病毒（HIV）的风险促使人们重新评估输血指征。1990年12月1日至1991年7月31日，对肯尼亚西部一家地区医院收治的女性进行了前瞻性监测，以了解血红蛋白（Hb）输血状况及转归。在2986名登记女性中（平均Hb 10.4 g/dL，标准差±2.6，中位年龄24.4岁），6%为严重贫血（Hb < 6.0 g/dL）。与Hb≥6.0 g/dL的女性相比，严重贫血与更高的死亡率相关（10.7%对1.4%，优势比（OR） = 8.2，95%置信区间（CI）2.6，34.2）。随着Hb值升高，住院死亡率降低（OR = 0.43，95% CI 0.19，0.98），但输血并未改善住院生存率（OR = 1.56，95% CI 0.22，11.03）。因HIV感染和严重贫血导致的可归因死亡率分别为75%和31%。母婴保健服务必须包括HIV传播的预防策略以及严重贫血的预防、识别和治疗。
