Sickle cell disease: acute lung disease: blood transfusions improved symptoms.

Clinical bottom line (level 4)

  1. Children with sickle cell disease and lung infection, infarction or acute chest syndrome improved clinically following blood transfusion (NNT = 1 at 48 hours) .
Mallouh and Asha: Archives of Diseases in Childhood 1988; 142: 178-182
Expires December 2003

The study

Retrospective cohort study with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.
Setting: acute hospital, Saudi Arabia

24 patients (aged range 2 to 15 years, 58% male) children with sickle cell disease and pneumonia, bronchopneumonia, pulmonary infarction or acute chest syndrome (i.e. with acute onset of respiratory distress)

Excluded if
  • >15 years old


    • Note:
  • All patients were febrile (range 37.7 ° C to 40.6 ° C). Eleven patients had painful vaso-occlusive crisis.


    • Control Group: (n = 9, 9 analysed): no blood transfusion
    Experimental Group: (n = 23, 23 analysed): blood transfusion within 24 hours of hospital admission
    All patients received ampicillin. The decision to give blood was taken by the treating clinician on the basis of the patient's response to initial therapy at 24 hours. Consequently, sicker patients received transfusion.
    100% followed for 48 hours
    Outcome notes:
    • no clinical improvement : decrease in toxic condition, decrease in respiratory rate and retraction) within 48 hours

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no clinical improvement 48 hours 5
    (55.6%)    		 0
    (0.00%)    		 100%
    (77% to 100%)    		 55.6%
    (23.1% to 88.0%)    		 2
    (1 to 4)

  • Patients in the no transfusion group who were given a late transfusion improved rapidly.

    • Comments

    1. The lack of blinding and subjective outcome make these results far less certain.

    Citation

    1. Mallouh AA, and Asha M: Beneficial effect of blood transfusion in children with sickle cell chest syndrome. Archives of Diseases in Childhood 1988; 142: 178-182
    Contributor: Nick Shenker and Clare Wotton, May 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell disease and respiratory distress
    Intervention or Exposure blood transfusion
    Comparison no blood transfusion
    Outcome clinical improvement