Premium
Transfusion management of severe anaemia in African children: a consensus algorithm
Author(s) -
Maitland Kathryn,
Kiguli Sarah,
OlupotOlupot Peter,
Opoka Robert O.,
Chimalizeni Yami,
Alaroker Florence,
Uyoga Sophie,
KyeyuneByabazaire Dorothy,
M’baya Bridon,
Bates Imelda,
Williams Thomas N.,
Munube Deogratias,
Mbanya Dora,
Molyneux Elizabeth M.,
South Annabelle,
Walker A. Sarah,
Gibb Diana M.,
George Elizabeth C.
Publication year - 2021
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.17429
Subject(s) - medicine , blood transfusion , malaria , intensive care medicine , anemia , pediatrics , blood management , shock (circulatory) , immunology
Summary The phase III Transfusion and Treatment of severe anaemia in African Children Trial (TRACT) found that conservative management of uncomplicated severe anaemia [haemoglobin (Hb) 40–60 g/l] was safe, and that transfusion volume (20 vs. 30 ml/kg whole blood equivalent) for children with severe anaemia (Hb <60 g/l) had strong but opposing effects on mortality, depending on fever status (>37·5°C). In 2020 a stakeholder meeting of paediatric and blood transfusion groups from Africa reviewed the results and additional analyses. Among all 3196 children 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 three 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.