1. Transfusion Volume for Children with Severe Anemia in Africa
- Author
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Maitland, K, Saunders, D, Olupot-Olupot, P, Kiguli, S, Chagaluka, G, Alaroker, F, Opoka, OR, Mpoya, A, Engoru, C, Nteziyaremye, J, Mallewa, M, Kennedy, N, Nakuya, M, Namayanja, C, Kayaga, J, Uyoga, S, Byabazaire, D, M’baya, B, Wabwire, B, Frost, G, Bates, I, Evans, JA, Williams, TN, Goncalves, P, George, EC, Gibb, DM, Walker, AS, Group, for the TRACT, Medical Research Council, Medical Research Council, UK, and Medical Research Council (MRC)
- Subjects
Male ,Malawi ,Pediatrics ,Blood transfusion ,Cost-Benefit Analysis ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Transfusion volume ,TRACT Group ,Hemoglobins ,0302 clinical medicine ,Uganda ,030212 general & internal medicine ,Child ,11 Medical and Health Sciences ,wh_155 ,Anemia ,Health Care Costs ,General Medicine ,ws_300 ,Child, Preschool ,Hospital admission ,Female ,Life Sciences & Biomedicine ,medicine.medical_specialty ,Fever ,Patient Readmission ,World health ,Severe anemia ,wb_356 ,03 medical and health sciences ,Medicine, General & Internal ,SDG 3 - Good Health and Well-being ,General & Internal Medicine ,parasitic diseases ,medicine ,Humans ,Blood Transfusion ,Science & Technology ,business.industry ,Infant ,Transfusion Reaction ,Length of Stay ,medicine.disease ,Malaria ,Hemoglobin ,business ,Follow-Up Studies - Abstract
Background: Severe anemia (hemoglobin level, Methods: In this factorial, open-label trial, we randomly assigned Ugandan and Malawian children 2 months to 12 years of age with a hemoglobin level of less than 6 g per deciliter and severity features (e.g., respiratory distress or reduced consciousness) to receive immediate blood transfusion with 20 ml per kilogram or 30 ml per kilogram. Three other randomized analyses investigated immediate as compared with no immediate transfusion, the administration of postdischarge micronutrients, and postdischarge prophylaxis with trimethoprim–sulfamethoxazole. The primary outcome was 28-day mortality.Results: A total of 3196 eligible children (median age, 37 months; 2050 [64.1%] with malaria) were assigned to receive a transfusion of 30 ml per kilogram (1598 children) or 20 ml per kilogram (1598 children) and were followed for 180 days. A total of 1592 children (99.6%) in the higher-volume group and 1596 (99.9%) in the lower-volume group started transfusion (median, 1.2 hours after randomization). The mean (±SD) volume of total blood transfused per child was 475±385 ml and 353±348 ml, respectively; 197 children (12.3%) and 300 children (18.8%) in the respective groups received additional transfusions. Overall, 55 children (3.4%) in the higher-volume group and 72 (4.5%) in the lower-volume group died before 28 days (hazard ratio, 0.76; 95% confidence interval [CI], 0.54 to 1.08; P=0.12 by log-rank test). This finding masked significant heterogeneity in 28-day mortality according to the presence or absence of fever (>37.5°C) at screening (P=0.001 after Sidak correction). Among the 1943 children (60.8%) without fever, mortality was lower with a transfusion volume of 30 ml per kilogram than with a volume of 20 ml per kilogram (hazard ratio, 0.43; 95% CI, 0.27 to 0.69). Among the 1253 children (39.2%) with fever, mortality was higher with 30 ml per kilogram than with 20 ml per kilogram (hazard ratio, 1.91; 95% CI, 1.04 to 3.49). There was no evidence of differences between the randomized groups in readmissions, serious adverse events, or hemoglobin recovery at 180 days.Conclusions: Overall mortality did not differ between the two transfusion strategies. (Funded by the Medical Research Council and Department for International Development, United Kingdom; TRACT Current Controlled Trials number, ISRCTN84086586.)
- Published
- 2019
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