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

Maitland, Kathryn, Kiguli, Sarah, Olupot‐Olupot, Peter, Opoka, Robert O., Chimalizeni, Yami, Alaroker, Florence, Uyoga, Sophie, Kyeyune‐Byabazaire, Dorothy, M’baya, Bridon, Bates, Imelda ORCID:, Williams, Thomas N., Munube, Deogratias, Mbanya, Dora, Molyneux, Elizabeth M., South, Annabelle, Walker, A. Sarah, Gibb, Diana M. and George, Elizabeth C. (2021) 'Transfusion management of severe anaemia in African children: a consensus algorithm'. British Journal of Haematology, Vol 193, Issue 6, pp. 1247-1259.

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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.

Item Type: Article
Corporate Authors: TRACT Stakeholders meeting group
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WB Practice of Medicine > Therapeutics > WB 356 Blood transfusion
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
WH Hemic and Lymphatic Systems > WH 20 Research (General)
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 300 Hemic and lymphatic system
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 10 May 2021 14:28
Last Modified: 02 Jul 2021 13:50


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