@article{Olupot-Olupot:2014:10.1186/1741-7015-12-67,
author = {Olupot-Olupot, K and Engoru, C and Thompson, J and Nteziyaremye, J and Chebet, M and Ssenyondo, T and Dambisya, CM and Okuuny, V and Wokulira, R and Amorut, D and Ongodia, P and Mpoya, A and Williams, TN and Uyoga, S and Macharia, A and Gibb, DM and Walker, AS and Maitland, K},
doi = {10.1186/1741-7015-12-67},
journal = {BMC Medicine},
title = {Phase II trial of standard versus increased transfusion volume in Ugandan children with acute severe anemia},
url = {http://dx.doi.org/10.1186/1741-7015-12-67},
volume = {12},
year = {2014}
}

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TY  - JOUR
AB  - Background: Severe anemia (SA, hemoglobin <6 g/dl) is a leading cause of pediatric hospital admission in Africa,with significant in-hospital mortality. The underlying etiology is often infectious, but specific pathogens are rarelyidentified. Guidelines developed to encourage rational blood use recommend a standard volume of whole blood(20 ml/kg) for transfusion, but this is commonly associated with a frequent need for repeat transfusion and pooroutcome. Evidence is lacking on what hemoglobin threshold criteria for intervention and volume are associatedwith the optimal survival outcomes.Methods: We evaluated the safety and efficacy of a higher volume of whole blood (30 ml/kg; Tx30: n = 78) againstthe standard volume (20 ml/kg; Tx20: n = 82) in Ugandan children (median age 36 months (interquartile range(IQR) 13 to 53)) for 24-hour anemia correction (hemoglobin >6 g/dl: primary outcome) and 28-day survival.Results: Median admission hemoglobin was 4.2 g/dl (IQR 3.1 to 4.9). Initial volume received followed therandomization strategy in 155 (97%) patients. By 24-hours, 70 (90%) children in the Tx30 arm had corrected SAcompared to 61 (74%) in the Tx20 arm; cause-specific hazard ratio = 1.54 (95% confidence interval 1.09 to 2.18, P = 0.01).From admission to day 28 there was a greater hemoglobin increase from enrollment in Tx30 (global P <0.0001).Serious adverse events included one non-fatal allergic reaction and one death in the Tx30 arm. There were sixdeaths in the Tx20 arm (P = 0.12); three deaths were adjudicated as possibly related to transfusion, but nonesecondary to volume overload.Conclusion: A higher initial transfusion volume prescribed at hospital admission was safe and resulted in anaccelerated hematological recovery in Ugandan children with SA. Future testing in a large, pragmatic clinicaltrial to establish the effect on short and longer-term survival is warranted.
AU  - Olupot-Olupot,K
AU  - Engoru,C
AU  - Thompson,J
AU  - Nteziyaremye,J
AU  - Chebet,M
AU  - Ssenyondo,T
AU  - Dambisya,CM
AU  - Okuuny,V
AU  - Wokulira,R
AU  - Amorut,D
AU  - Ongodia,P
AU  - Mpoya,A
AU  - Williams,TN
AU  - Uyoga,S
AU  - Macharia,A
AU  - Gibb,DM
AU  - Walker,AS
AU  - Maitland,K
DO  - 10.1186/1741-7015-12-67
PY  - 2014///
SN  - 1741-7015
TI  - Phase II trial of standard versus increased transfusion volume in Ugandan children with acute severe anemia
T2  - BMC Medicine
UR  - http://dx.doi.org/10.1186/1741-7015-12-67
UR  - http://hdl.handle.net/10044/1/28277
VL  - 12
ER  - 

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