Liberal vs. Conservative Approach to Timing of Blood Transfusion in Severely Anemic Children

Abstract

In this open label trial, children aged 2 months to 12 years with uncomplicated severe anemia received immediate blood transfusion in the intervention group while in the control group, immediate transfusion was withheld. Children in the intervention group were further randomized to receive higher (30 mL/kg whole blood/ 15 mL/kg packed cells) or lower (20 mL/kg whole blood/ 10 mL/kg packed cells) volume, administered immediately after enrolment. Hemoglobin (Hb) was measured 8-hourly, and an additional transfusion using the original volume was given if the criteria for transfusion were met. For children requiring further transfusions, only 20 mL/kg whole blood (or 10 mL/kg packed cells) was used. In the control group, transfusion with 20 mL/kg of whole-blood equivalent was triggered by new signs of clinical severity or a drop in Hb to below 4 g/dL during 8-hourly monitoring, The primary out-come was 28-day mortality. Three other randomizations investigated transfusion volume, post-discharge supplementation with micronutrients, and post-discharge prophylaxis with trimethoprim-sulfamethoxazole.