Transfusion management of severe anaemia in African children: a consensus algorithm. (6th May 2021)

• Record Type: Journal Article
• Authors: Maitland, Kathryn; Kiguli, Sarah; Olupot‐Olupot, Peter; Opoka, Robert O.; Chimalizeni, Yami; Alaroker, Florence; Uyoga, Sophie; Kyeyune‐Byabazaire, 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.
• Other Names: Bongomin Bodo investigator.; Nabawanuka Eva investigator.; Musoke Philippa investigator.; Nasiima Ritah investigator.; Mnjalla Hellen investigator.; Mogaka Christabel investigator.; Bah Abubakarr investigator.; Umuhoza Christian investigator.; Obeng William K. A. investigator.; Kilba Charlyne investigator.; Appiah John investigator.; Ticklay Ismail investigator.; Ware Russel investigator.; Petrucci Roberta investigator.; Mberi ET investigator.; Tagny Claude T. investigator.; Diop Saliou investigator.; Moftah Faten investigator.; Acquah Michael E. investigator.; Olatunji Philip investigator.; Lyimo Magdalena investigator.; Anani Ludovic investigator.; Ofori Shirley O. investigator.; Engoru Charles investigator.
• Is Part Of: British journal of haematology. Volume 193:Number 6(2021)
• Page Start: 1247
• Page End: 1259
• Publication Date: 2021-05-06
• Subjects: anaemia -- African children -- transfusion -- guidelines -- malaria; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.17429
• Languages: English
• ISSNs: 0007-1048

Abstract

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.