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@article{Maitland:2019:10.1056/NEJMoa1900100,
author = {Maitland, K and Olupot-Olupot, P and Kiguli, S and Chagaluka, G and Alaroker, F and Opoka, RO and Mpoya, A and Engoru, C and Nteziyaremye, J and Mallewa, M and Kennedy, N and Nakuya, M and Namayanja, C and Kayaga, J and Uyoga, S and Byabazaire, DK and M'baya, B and Wabwire, B and Frost, G and Bates, I and Evans, JA and Williams, TN and Goncalves, PS and George, EC and Gibb, DM and Walker, AS},
doi = {10.1056/NEJMoa1900100},
journal = {New England Journal of Medicine},
pages = {420--431},
title = {Transfusion Volume for Children with Severe Anemia in Africa},
url = {http://dx.doi.org/10.1056/NEJMoa1900100},
volume = {381},
year = {2019}
}

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TY  - JOUR
AB  - BackgroundSevere anemia (hemoglobin level, <6 g per deciliter) is a leading cause of hospital admission and death in children in sub-Saharan Africa. The World Health Organization recommends transfusion of 20 ml of whole-blood equivalent per kilogram of body weight for anemia, regardless of hemoglobin level.MethodsIn this factorial, open-label trial, we randomly assigned Ugandan and Malawian children 2 months to 12 years of age with a hemoglobin level of less than 6 g per deciliter and severity features (e.g., respiratory distress or reduced consciousness) to receive immediate blood transfusion with 20 ml per kilogram or 30 ml per kilogram. Three other randomized analyses investigated immediate as compared with no immediate transfusion, the administration of postdischarge micronutrients, and postdischarge prophylaxis with trimethoprim–sulfamethoxazole. The primary outcome was 28-day mortality.ResultsA total of 3196 eligible children (median age, 37 months; 2050 [64.1%] with malaria) were assigned to receive a transfusion of 30 ml per kilogram (1598 children) or 20 ml per kilogram (1598 children) and were followed for 180 days. A total of 1592 children (99.6%) in the higher-volume group and 1596 (99.9%) in the lower-volume group started transfusion (median, 1.2 hours after randomization). The mean (±SD) volume of total blood transfused per child was 475±385 ml and 353±348 ml, respectively; 197 children (12.3%) and 300 children (18.8%) in the respective groups received additional transfusions. Overall, 55 children (3.4%) in the higher-volume group and 72 (4.5%) in the lower-volume group died before 28 days (hazard ratio, 0.76; 95% confidence interval [CI], 0.54 to 1.08; P=0.12 by log-rank test). This finding masked significant heterogeneity in 28-day mortality according to the presence or absence of fever (>37.5°C) at screening (P=0.001 after Sidak correction). Among the 1943 children (60.8%) without fever, mortality was lower with
AU  - Maitland,K
AU  - Olupot-Olupot,P
AU  - Kiguli,S
AU  - Chagaluka,G
AU  - Alaroker,F
AU  - Opoka,RO
AU  - Mpoya,A
AU  - Engoru,C
AU  - Nteziyaremye,J
AU  - Mallewa,M
AU  - Kennedy,N
AU  - Nakuya,M
AU  - Namayanja,C
AU  - Kayaga,J
AU  - Uyoga,S
AU  - Byabazaire,DK
AU  - M'baya,B
AU  - Wabwire,B
AU  - Frost,G
AU  - Bates,I
AU  - Evans,JA
AU  - Williams,TN
AU  - Goncalves,PS
AU  - George,EC
AU  - Gibb,DM
AU  - Walker,AS
DO  - 10.1056/NEJMoa1900100
EP  - 431
PY  - 2019///
SN  - 0028-4793
SP  - 420
TI  - Transfusion Volume for Children with Severe Anemia in Africa
T2  - New England Journal of Medicine
UR  - http://dx.doi.org/10.1056/NEJMoa1900100
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000478064200007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/72729
VL  - 381
ER  -

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