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 CME credits approval pending.
Accredited by CPDUK, CBRN and Provider Pending.

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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