Transfusion management of severe anaemia in African children: a consensus algorithm
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...
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| Veröffentlicht in: | British journal of haematology 2021-06, Vol.193 (6), p.1247-1259 |
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| creator | 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. Bongomin, Bodo Nabawanuka, Eva Musoke, Philippa Nasiima, Ritah Mnjalla, Hellen Mogaka, Christabel Bah, Abubakarr Umuhoza, Christian Obeng, William K. A. Kilba, Charlyne Appiah, John Ticklay, Ismail Ware, Russel Petrucci, Roberta Mberi, ET Tagny, Claude T. Diop, Saliou Moftah, Faten Acquah, Michael E. Olatunji, Philip Lyimo, Magdalena Anani, Ludovic Ofori, Shirley O. Engoru, Charles |
| description | 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 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. |
| doi_str_mv | 10.1111/bjh.17429 |
| format | Article |
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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.</description><identifier>ISSN: 0007-1048</identifier><identifier>EISSN: 1365-2141</identifier><identifier>DOI: 10.1111/bjh.17429</identifier><identifier>PMID: 33955552</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Africa - epidemiology ; African children ; Algorithms ; anaemia ; Anemia ; Anemia, Sickle Cell - epidemiology ; Anemia, Sickle Cell - therapy ; Blood Transfusion ; Child ; Child, Preschool ; Children ; Consensus ; Diuretics ; Fever ; guidelines ; Hematology ; Hemoglobin ; Humans ; Malaria ; Malaria - epidemiology ; Malaria - therapy ; Male ; Nutritional status ; Parasites ; Severity of Illness Index ; Sickle cell disease ; transfusion</subject><ispartof>British journal of haematology, 2021-06, Vol.193 (6), p.1247-1259</ispartof><rights>2021 The Authors. published by British Society for Haematology and John Wiley & Sons Ltd.</rights><rights>2021 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4439-63cd7c29d6842d8f58b0f261854ff196db7433ea4ae62232bb1e544104e266633</citedby><cites>FETCH-LOGICAL-c4439-63cd7c29d6842d8f58b0f261854ff196db7433ea4ae62232bb1e544104e266633</cites><orcidid>0000-0002-9738-5490 ; 0000-0001-8912-2001 ; 0000-0001-5479-5900 ; 0000-0002-5757-609X ; 0000-0002-1312-6804 ; 0000-0003-0119-804X ; 0000-0003-1746-7873 ; 0000-0002-0862-8199 ; 0000-0001-7705-8081 ; 0000-0002-0412-8509 ; 0000-0002-2928-3580 ; 0000-0003-4456-2382 ; 0000-0003-3240-2058 ; 0000-0002-0007-0645</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbjh.17429$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbjh.17429$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33955552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maitland, Kathryn</creatorcontrib><creatorcontrib>Kiguli, Sarah</creatorcontrib><creatorcontrib>Olupot‐Olupot, Peter</creatorcontrib><creatorcontrib>Opoka, Robert O.</creatorcontrib><creatorcontrib>Chimalizeni, Yami</creatorcontrib><creatorcontrib>Alaroker, Florence</creatorcontrib><creatorcontrib>Uyoga, Sophie</creatorcontrib><creatorcontrib>Kyeyune‐Byabazaire, Dorothy</creatorcontrib><creatorcontrib>M’baya, Bridon</creatorcontrib><creatorcontrib>Bates, Imelda</creatorcontrib><creatorcontrib>Williams, Thomas N.</creatorcontrib><creatorcontrib>Munube, Deogratias</creatorcontrib><creatorcontrib>Mbanya, Dora</creatorcontrib><creatorcontrib>Molyneux, Elizabeth M.</creatorcontrib><creatorcontrib>South, Annabelle</creatorcontrib><creatorcontrib>Walker, A. Sarah</creatorcontrib><creatorcontrib>Gibb, Diana M.</creatorcontrib><creatorcontrib>George, Elizabeth C.</creatorcontrib><creatorcontrib>Bongomin, Bodo</creatorcontrib><creatorcontrib>Nabawanuka, Eva</creatorcontrib><creatorcontrib>Musoke, Philippa</creatorcontrib><creatorcontrib>Nasiima, Ritah</creatorcontrib><creatorcontrib>Mnjalla, Hellen</creatorcontrib><creatorcontrib>Mogaka, Christabel</creatorcontrib><creatorcontrib>Bah, Abubakarr</creatorcontrib><creatorcontrib>Umuhoza, Christian</creatorcontrib><creatorcontrib>Obeng, William K. A.</creatorcontrib><creatorcontrib>Kilba, Charlyne</creatorcontrib><creatorcontrib>Appiah, John</creatorcontrib><creatorcontrib>Ticklay, Ismail</creatorcontrib><creatorcontrib>Ware, Russel</creatorcontrib><creatorcontrib>Petrucci, Roberta</creatorcontrib><creatorcontrib>Mberi, ET</creatorcontrib><creatorcontrib>Tagny, Claude T.</creatorcontrib><creatorcontrib>Diop, Saliou</creatorcontrib><creatorcontrib>Moftah, Faten</creatorcontrib><creatorcontrib>Acquah, Michael E.</creatorcontrib><creatorcontrib>Olatunji, Philip</creatorcontrib><creatorcontrib>Lyimo, Magdalena</creatorcontrib><creatorcontrib>Anani, Ludovic</creatorcontrib><creatorcontrib>Ofori, Shirley O.</creatorcontrib><creatorcontrib>Engoru, Charles</creatorcontrib><creatorcontrib>TRACT Stakeholders meeting group</creatorcontrib><title>Transfusion management of severe anaemia in African children: a consensus algorithm</title><title>British journal of haematology</title><addtitle>Br J Haematol</addtitle><description>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.</description><subject>Africa - epidemiology</subject><subject>African children</subject><subject>Algorithms</subject><subject>anaemia</subject><subject>Anemia</subject><subject>Anemia, Sickle Cell - epidemiology</subject><subject>Anemia, Sickle Cell - therapy</subject><subject>Blood Transfusion</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Consensus</subject><subject>Diuretics</subject><subject>Fever</subject><subject>guidelines</subject><subject>Hematology</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Malaria</subject><subject>Malaria - epidemiology</subject><subject>Malaria - therapy</subject><subject>Male</subject><subject>Nutritional status</subject><subject>Parasites</subject><subject>Severity of Illness Index</subject><subject>Sickle cell disease</subject><subject>transfusion</subject><issn>0007-1048</issn><issn>1365-2141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kU1rFTEUhoMo9lpd-Ack4EYX0-bka2ZcCLVYqxRcWNchkzm5N5eZpCZ3Kv33pr21qODZBHIeHt7DS8hLYEdQ53jYbo6glbx_RFYgtGo4SHhMVoyxtgEmuwPyrJQtYyCYgqfkQIhe1eEr8u0y21j8UkKKdLbRrnHGuKPJ04LXmJHWP5yDpSHSE5-Ds5G6TZjGjPEdtdSlWDCWpVA7rVMOu838nDzxdir44v49JN_PPl6enjcXXz99Pj25aJyUom-0cGPreD_qTvKx86obmOcaOiW9h16PQyuFQCstas4FHwZAJWW9B7nWWohD8n7vvVqGGUdXc2c7mascZptvTLLB_L2JYWPW6dq0GkBAXwVv7gU5_Viw7MwcisNpshHTUgxXnGsuGJMVff0Puk1LjvW8SkkQSkh1S73dUy6nUjL6hzDAzG1VplZl7qqq7Ks_0z-Qv7upwPEe-BkmvPm_yXz4cr5X_gJ1Wp0e</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Maitland, Kathryn</creator><creator>Kiguli, Sarah</creator><creator>Olupot‐Olupot, Peter</creator><creator>Opoka, Robert O.</creator><creator>Chimalizeni, Yami</creator><creator>Alaroker, Florence</creator><creator>Uyoga, Sophie</creator><creator>Kyeyune‐Byabazaire, Dorothy</creator><creator>M’baya, Bridon</creator><creator>Bates, Imelda</creator><creator>Williams, Thomas N.</creator><creator>Munube, Deogratias</creator><creator>Mbanya, Dora</creator><creator>Molyneux, Elizabeth M.</creator><creator>South, Annabelle</creator><creator>Walker, A. 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Sarah</au><au>Gibb, Diana M.</au><au>George, Elizabeth C.</au><au>Bongomin, Bodo</au><au>Nabawanuka, Eva</au><au>Musoke, Philippa</au><au>Nasiima, Ritah</au><au>Mnjalla, Hellen</au><au>Mogaka, Christabel</au><au>Bah, Abubakarr</au><au>Umuhoza, Christian</au><au>Obeng, William K. A.</au><au>Kilba, Charlyne</au><au>Appiah, John</au><au>Ticklay, Ismail</au><au>Ware, Russel</au><au>Petrucci, Roberta</au><au>Mberi, ET</au><au>Tagny, Claude T.</au><au>Diop, Saliou</au><au>Moftah, Faten</au><au>Acquah, Michael E.</au><au>Olatunji, Philip</au><au>Lyimo, Magdalena</au><au>Anani, Ludovic</au><au>Ofori, Shirley O.</au><au>Engoru, Charles</au><aucorp>TRACT Stakeholders meeting group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transfusion management of severe anaemia in African children: a consensus algorithm</atitle><jtitle>British journal of haematology</jtitle><addtitle>Br J Haematol</addtitle><date>2021-06</date><risdate>2021</risdate><volume>193</volume><issue>6</issue><spage>1247</spage><epage>1259</epage><pages>1247-1259</pages><issn>0007-1048</issn><eissn>1365-2141</eissn><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.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>33955552</pmid><doi>10.1111/bjh.17429</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-9738-5490</orcidid><orcidid>https://orcid.org/0000-0001-8912-2001</orcidid><orcidid>https://orcid.org/0000-0001-5479-5900</orcidid><orcidid>https://orcid.org/0000-0002-5757-609X</orcidid><orcidid>https://orcid.org/0000-0002-1312-6804</orcidid><orcidid>https://orcid.org/0000-0003-0119-804X</orcidid><orcidid>https://orcid.org/0000-0003-1746-7873</orcidid><orcidid>https://orcid.org/0000-0002-0862-8199</orcidid><orcidid>https://orcid.org/0000-0001-7705-8081</orcidid><orcidid>https://orcid.org/0000-0002-0412-8509</orcidid><orcidid>https://orcid.org/0000-0002-2928-3580</orcidid><orcidid>https://orcid.org/0000-0003-4456-2382</orcidid><orcidid>https://orcid.org/0000-0003-3240-2058</orcidid><orcidid>https://orcid.org/0000-0002-0007-0645</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0007-1048 |
| ispartof | British journal of haematology, 2021-06, Vol.193 (6), p.1247-1259 |
| issn | 0007-1048 1365-2141 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7611319 |
| source | Wiley Free Content; Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | Africa - epidemiology African children Algorithms anaemia Anemia Anemia, Sickle Cell - epidemiology Anemia, Sickle Cell - therapy Blood Transfusion Child Child, Preschool Children Consensus Diuretics Fever guidelines Hematology Hemoglobin Humans Malaria Malaria - epidemiology Malaria - therapy Male Nutritional status Parasites Severity of Illness Index Sickle cell disease transfusion |
| title | Transfusion management of severe anaemia in African children: a consensus algorithm |
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