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Transfusion management of severe anaemia in African children: a consensus algorithm

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Title: Transfusion management of severe anaemia in African children: a consensus algorithm
Authors: Maitland, K
Kiguli, S
Olupot-Olupot, P
Opoka, RO
Chimalizeni, Y
Alaroker, F
Uyoga, S
Kyeyune Byabazaire, D
M’baya, B
Bates, I
Williams, TN
Mbanya, D
Munube, D
Molyneux, EM
South, A
Walker, AS
Gibb, DM
George, EM
Item Type: Journal Article
Abstract: The phase III Transfusion and Treatment of severe anaemia in African Children Trial(TRACT) found that conservative management of uncomplicated severe anaemia (haemoglobin(Hb)4-6g/dl) was safe and that transfusion volume(20 versus30 mls/kg whole blood equivalent)for children with severe anaemia (Hb<6g/dl) had strong but opposing effects on mortality, depending on fever status (>37.5oC). In 2020 a stakeholder meeting of paediatric and blood transfusion groups from Africa reviewed the results and additional analyses. Among all children (3196) receiving an initial transfusion, there was no evidence that nutritional status, presence of shock, malaria parasite burden, or sickle cell disease status influenced outcomes, or modified the interaction with fever status on volume required. Fever status at the time of ordering blood was a reliable determinant of volume required for optimal outcome. Elevated heart and respiratory rates normalised irrespective of transfusion volume and without diuretics. By consensus, a transfusion management algorithm was developed, incorporating 3 additional measurements of Hb post-admission, alongside clinical monitoring. The proposed algorithm should help clinicians safely implement findings from TRACT. Further research should assess its implementation in routine clinical practice
Issue Date: Jun-2021
Date of Acceptance: 18-Feb-2021
URI: http://hdl.handle.net/10044/1/88206
DOI: 10.1111/bjh.17429
ISSN: 0007-1048
Publisher: Wiley
Start Page: 1247
End Page: 1259
Journal / Book Title: British Journal of Haematology
Volume: 193
Issue: 6
Copyright Statement: © 2021 The Authors. British Journal of Haematology published by British Society for Haematologyand John Wiley & Sons Ltd.. British Journal of Haematology, 2021, 193, 1247–1259This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in anymedium, provided the original work is properly cited.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council
Medical Research Council
Wellcome Trust
Funder's Grant Number: MR/J012483/1
MR/J012483/1
MR/J012483/1
202800/Z/16/Z
Keywords: Science & Technology
Life Sciences & Biomedicine
Hematology
anaemia
African children
transfusion
guidelines
malaria
BLOOD-TRANSFUSION
VOLUME
African children
anaemia
guidelines
malaria
transfusion
TRACT Stakeholders meeting group
Immunology
1102 Cardiorespiratory Medicine and Haematology
Publication Status: Published
Online Publication Date: 2021-05-06
Appears in Collections:Department of Surgery and Cancer
Department of Infectious Diseases
Faculty of Medicine