Dear CHIFA colleagues,
I am writing to share a paper that has recently been published that contains a consensus algorithm for the transfusion management of children with severe anaemia in Africa
https://onlinelibrary.wiley.com/doi/10.1111/bjh.17429
There's also a shorter briefing paper that gives the algorithm and the rationale behind it
https://www.ctu.mrc.ac.uk/media/1972/tract-algorithm-briefing.pdf
Here are the key consensus recommendations:
* Children with uncomplicated severe anaemia (haemoglobin (Hb) 4-6g/dl and no severity features) can be safely managed, with Hb monitoring at 8hr, 24hr and 48hr, and no transfusion unless severity features develop or Hb falls below 4g/dl
* Children with haemoglobin less than 6g/dl, or who have already received a transfusion, should be monitored clinically for severity features at least at 4hr, 8hr, 24hr and 48hr, and given a transfusion if a new severity feature develops
* Access to prompt and accurate haemoglobin tests is important for implementing this strategy
* The volume of blood required for a transfusion in children with Hb<4g/dl or 4-6g/dl and severity features depends on the child's temperature at the time of ordering blood:
* 30mls/kg whole blood if their temperature is less than or equal to 37.5 degrees C
* 20mls/kg whole blood if their temperature is more than 37.5 degrees C
* Implementing this stratified approach to treating children with complicated severe anaemia could save substantial numbers of lives in sub-Saharan Africa each year
* Children with sickle cell disease can be treated using the same algorithm, unless they have suspected cerebral vascular accident/stroke, or acute splenic sequestration, when dedicated management guidelines should be followed
The paper provides the rationale for these recommendations, which are based on analyses of data from the TRACT trial.
Best wishes,
Annabelle South
CHIFA Profile: Annabelle South is Policy, Communications & Research Impact Coordinator at the MRC Clinical Trials Unit at UCL, London, UK. She is interested in paediatric health research, particularly HIV and TB.
emaIL: a.south AT ucl.ac.uk
