Efficacy of packed red blood cell transfusions based on weight versus formula in thalassemic children: An open-label randomized control trial.

Abstract

Protocols for transfusion therapy in transfusion-dependent thalassemia (TDT) children differ among various medical centers. In India, most centers consider only the patient's weight while calculating the volume of packed red blood cells (PRBCs) to be transfused. This study aimed to compare the efficacy of PRBC transfusions of different volumes calculated either by weight or by a formula using weight and pretransfusion hemoglobin of patient and hematocrit of PRBC. Sixty TDT patients in the age group of 3-9 years were enrolled and randomly allocated to two groups. Group A received PRBC transfusion volume based on the patient's weight, and Group B received PRBC volume calculated using a formula for 6 months. Average pretransfusion hemoglobin in Group A and Group B (9± 0.4 vs. 8.9± 0.4g/dl) was not significantly different (p= .353). Although the average number of visits in 6months was less for Group A compared to Group B (7± 1 vs. 8± 1; p= .001); the average volume transfused per visit was more (351 ± 78 vs. 287 ± 68 ml; p= .003). The calculated average annual pure red cell requirement of the patients was 178 ml/kg/year for Group A and 154 ml/kg/year for Group B (p= .000). Total donor exposures were significantly lower in Group B than Group A (11 ± 3 vs. 14 ± 3; p= .006). The number of donor exposures and annual pure red cell requirement was significantly lower in the formula-based group. Transfusions based on formula are recommended in TDT patients.