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Is the packed cell volume ÷ 3 rule valid for estimating haemoglobin in children in malarious areas?
  1. Wilma Francisca Tanga1,
  2. Andrew James McArdle2
  1. 1Department of Medicine, Connaught Hospital, Freetown, Sierra Leone
  2. 2Paediatric Infectious Diseases, St Mary’s Hospital, London, UK
  1. Correspondence to Dr Wilma Francisca Tanga, Medicine, Connaught Hospital, Freetown, Sierra Leone; franciswil2007{at}gmail.com

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Scenario

You are working in a regional hospital in Sierra Leone. A 3-year-old child arrives with a history of fever, progressive weakness, reduced consciousness and convulsions. On examination, she has moderate respiratory distress, looks very pale and is unconscious. Her malaria rapid diagnostic test is positive. A spun packed cell volume (PCV) is 20%, leading to a haemoglobin (Hb) estimate of 6.7 g/dL. You ask yourself how accurate this estimate of Hb is, and whether you should transfuse the child regardless.

Structured clinical question

In children in malarious areas attending hospital with acute illness (patient) how accurate is PCV÷3 (investigation) compared with haemoglobin (comparison) in diagnosing severe anaemia (outcome)?

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