Transfusion management of severe anaemia in African children: a consensus algorithm.
Br J Haematol
; 193(6): 1247-1259, 2021 06.
Article
em En
| MEDLINE
| ID: mdl-33955552
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) 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.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Transfusão de Sangue
/
Algoritmos
/
Consenso
/
Anemia Falciforme
/
Malária
Tipo de estudo:
Clinical_trials
/
Guideline
/
Prognostic_studies
Limite:
Child
/
Child, preschool
/
Humans
/
Male
País/Região como assunto:
Africa
Idioma:
En
Revista:
Br J Haematol
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Reino Unido