Algorithm for transfusion management of children with severe anaemia published

10 May 2021

A new consensus algorithm that could save the lives of children with severe anaemia in sub-Saharan Africa has been published in the British Journal of Haematology.

The algorithm provides guidance for healthcare workers on how to look after children with severe anaemia. It is based on analysis of data from the TRACT trial, and was developed at a stakeholder meeting co-hosted by the African Society for Blood Transfusion and the Ugandan Paediatric Association.

The algorithm provides practical recommendations about which tests need to be carried out on children presenting at hospital with suspected severe anaemia, which children require transfusions, how much blood they should be given, and what monitoring should be carried out.

The paper also provides a handy blood dosing chart, allowing healthworkers to easily look up how much blood is needed, depending on a child’s weight.

Severe anaemia is common and life-threatening for children in sub-Saharan Africa. Around one in ten children in hospital because of severe anaemia die while in hospital, and one in eight die within six months of being discharged from hospital. One in six children end up back in hospital within six months of being discharged.

The TRACT trial showed that the amount of blood children with complicated severe anaemia should be given varies, depending on whether the child has a fever. Children who received the appropriate amount of blood, depending on whether they had fever or not, were at about half the risk of dying compared to those who received the other amount.

TRACT also showed that children with uncomplicated severe anaemia 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.

Kath Maitland, from Imperial College London, who was Chief Investigator of the TRACT trial, said “We showed, in the TRACT trial, that giving children with severe anaemia the right amount of blood can save lives. We hope that this algorithm will help healthcare workers provide effective, evidence-based care for children with severe anaemia. It will also help health services preserve scarce supplies of blood for those who will really benefit from it.”

Further information