ABSTRACT
In a rural hospital in Malawi a protocol was developed for the treatment of severely anaemic children to improve the chances of survival of children with haemoglobin levels of 5 g/dl or less (referred to here as severe anaemia); and also to reduce the risks of transmission of human immunodeficiency virus (HIV) by blood transfusion in a unit where the routine screening of donated blood for HIV positivity is not available. Comparison of the results of applying the protocol (using digoxin; frusemide and selective delayed transfusion) with the results of using a widely accepted regimen of routine transfusion of all children with haemoglobin (Hb) of 5 g/dl or less suggests that stabilization of a severely anaemic child's cardiac state before transfusion improves the chances of survival. Many children with very low haemoglobin values do not then require transfusion; thus avoiding the dangers of transfusing blood that is potentially HIV positive. Those who do need transfusion withstand the procedure better