Immediate transfusion in African children with uncomplicated severe anemia
<p>BACKGROUND</p> <p>The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates s...
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Format: | Journal article |
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Massachusetts Medical Society
2019
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author | Maitland, K Kiguli, S Olupot-Olupot, P Walker, S |
author2 | for the TRACT Group |
author_facet | for the TRACT Group Maitland, K Kiguli, S Olupot-Olupot, P Walker, S |
author_sort | Maitland, K |
collection | OXFORD |
description | <p>BACKGROUND</p> <p>The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes.</p> <br/> <p>METHODS</p> <p>In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter. The primary outcome was 28-day mortality. Three other randomizations investigated transfusion volume, postdischarge supplementation with micronutrients, and postdischarge prophylaxis with trimethoprim–sulfamethoxazole.</p> <br/> <p>RESULTS</p> <p>A total of 1565 children (median age, 26 months) underwent randomization, with 778 assigned to the immediate-transfusion group and 787 to the control group; 984 children (62.9%) had malaria. The children were followed for 180 days, and 71 (4.5%) were lost to follow-up. During the primary hospitalization, transfusion was performed in all the children in the immediate-transfusion group and in 386 (49.0%) in the control group (median time to transfusion, 1.3 hours vs. 24.9 hours after randomization). The mean (±SD) total blood volume transfused per child was 314±228 ml in the immediate-transfusion group and 142±224 ml in the control group. Death had occurred by 28 days in 7 children (0.9%) in the immediate-transfusion group and in 13 (1.7%) in the control group (hazard ratio, 0.54; 95% confidence interval [CI], 0.22 to 1.36; P=0.19) and by 180 days in 35 (4.5%) and 47 (6.0%), respectively (hazard ratio, 0.75; 95% CI, 0.48 to 1.15), without evidence of interaction with other randomizations (P>0.20) or evidence of between-group differences in readmissions, serious adverse events, or hemoglobin recovery at 180 days. The mean length of hospital stay was 0.9 days longer in the control group.</p> <br/> <p>CONCLUSIONS</p> <p>There was no evidence of differences in clinical outcomes over 6 months between the children who received immediate transfusion and those who did not. The triggered-transfusion strategy in the control group resulted in lower blood use; however, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring.</p> |
first_indexed | 2024-03-06T23:35:30Z |
format | Journal article |
id | oxford-uuid:6d846421-cfde-4285-b19a-c2c93d5b92c2 |
institution | University of Oxford |
last_indexed | 2024-03-06T23:35:30Z |
publishDate | 2019 |
publisher | Massachusetts Medical Society |
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spelling | oxford-uuid:6d846421-cfde-4285-b19a-c2c93d5b92c22022-03-26T19:18:18ZImmediate transfusion in African children with uncomplicated severe anemiaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6d846421-cfde-4285-b19a-c2c93d5b92c2Symplectic Elements at OxfordMassachusetts Medical Society2019Maitland, KKiguli, SOlupot-Olupot, PWalker, Sfor the TRACT Group<p>BACKGROUND</p> <p>The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes.</p> <br/> <p>METHODS</p> <p>In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter. The primary outcome was 28-day mortality. Three other randomizations investigated transfusion volume, postdischarge supplementation with micronutrients, and postdischarge prophylaxis with trimethoprim–sulfamethoxazole.</p> <br/> <p>RESULTS</p> <p>A total of 1565 children (median age, 26 months) underwent randomization, with 778 assigned to the immediate-transfusion group and 787 to the control group; 984 children (62.9%) had malaria. The children were followed for 180 days, and 71 (4.5%) were lost to follow-up. During the primary hospitalization, transfusion was performed in all the children in the immediate-transfusion group and in 386 (49.0%) in the control group (median time to transfusion, 1.3 hours vs. 24.9 hours after randomization). The mean (±SD) total blood volume transfused per child was 314±228 ml in the immediate-transfusion group and 142±224 ml in the control group. Death had occurred by 28 days in 7 children (0.9%) in the immediate-transfusion group and in 13 (1.7%) in the control group (hazard ratio, 0.54; 95% confidence interval [CI], 0.22 to 1.36; P=0.19) and by 180 days in 35 (4.5%) and 47 (6.0%), respectively (hazard ratio, 0.75; 95% CI, 0.48 to 1.15), without evidence of interaction with other randomizations (P>0.20) or evidence of between-group differences in readmissions, serious adverse events, or hemoglobin recovery at 180 days. The mean length of hospital stay was 0.9 days longer in the control group.</p> <br/> <p>CONCLUSIONS</p> <p>There was no evidence of differences in clinical outcomes over 6 months between the children who received immediate transfusion and those who did not. The triggered-transfusion strategy in the control group resulted in lower blood use; however, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring.</p> |
spellingShingle | Maitland, K Kiguli, S Olupot-Olupot, P Walker, S Immediate transfusion in African children with uncomplicated severe anemia |
title | Immediate transfusion in African children with uncomplicated severe anemia |
title_full | Immediate transfusion in African children with uncomplicated severe anemia |
title_fullStr | Immediate transfusion in African children with uncomplicated severe anemia |
title_full_unstemmed | Immediate transfusion in African children with uncomplicated severe anemia |
title_short | Immediate transfusion in African children with uncomplicated severe anemia |
title_sort | immediate transfusion in african children with uncomplicated severe anemia |
work_keys_str_mv | AT maitlandk immediatetransfusioninafricanchildrenwithuncomplicatedsevereanemia AT kigulis immediatetransfusioninafricanchildrenwithuncomplicatedsevereanemia AT olupotolupotp immediatetransfusioninafricanchildrenwithuncomplicatedsevereanemia AT walkers immediatetransfusioninafricanchildrenwithuncomplicatedsevereanemia |