Anaemia and Transfusion: lessons from the TRACT trial

A review of the evidence

The lecture duration is 30min.

0.5 CPD Points, 0.5 CEUs, 0.5 AMA PRA Category 1 Credits.
Accredited by CPDUK, CBRN and EB Medicine.

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Kathryn Maitland
Professor of Paediatric Tropical Infectious Diseases, Imperial College, London
Lecture Summary

Severe anaemia is a common and life-threatening cause of admission in children in sub-Saharan Africa(sSA) ~ 10% will die in hospital, and ~ 12% die 6 months post-discharge l. Whilst blood transfusions are an important treatment for severe anaemia, scientific evidence to guide doctors on how much blood to give children, or which children require it is poor. The TRACT trial showed that children with complicated severe anaemia (Hb <4g/dl or 4-6g/dl with severity signs) who do not have a fever require a larger volume of blood transfusion (30mls/kg whole blood) than current WHO guidelines recommend- halving mortality. Conversely, for children with a high temperature, guideline-recommendations (20mls./kg) are correct. The TRACT trial also showed that children with uncomplicated severe anaemia (no severity signs, haemoglobin 4-6g/dl) do not require an immediate transfusion, as long as they are closely monitored for signs of complications, or their haemoglobin levels dropping, and receive a transfusion at that point.

Target Audience

Critical Care Doctors
Experienced or advanced Critical Care Nurses

Learning Objectives:

Upon completion of this activity, you should be able to:

  • Discuss why transfusion guidelines in Africa differ from high-income countries
  • Explore the safety of whole blood versus packed cells
  • Explore the impact of donor blood age (time from collection to transfusion) on outcomes
  • Understand the burden of Sickle Cell Disease on the blood transfusion services in Africa
  • Discuss the impact of severe anaemia on African children and the ensuing risk of heart failure

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of EB Medicine and Continulus. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

EB Medicine designates this internet-enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Needs Assessment

The need for this educational activity was determined by surveys of the target audience and experts in the specialty. Further assessment was provided by examining the topics of recently published evidence-based medicine reviews, national clinical guidelines, and specialty society recommendations, as well as suggestions from evaluations of previous learning programs to determine practice gaps.

CME Faculty Disclosure

It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME accreditation requirements and policies, all faculty for this CME activity were asked to complete a full disclosure statement. The speaker did not report any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.

Earning Credit

In order to earn CME credit, the participant must take the pre-test, watch the course, take the CME post-test, and complete the post-test evaluation.

Hardware/Software Requirements

Online learners will need a computer or web-enabled device to access the podcast, additional learning materials, and CME test.

Commercial Support

This activity received no commercial support.