Anaemia and Transfusion: lessons from the TRACT trial

Professor Kathryn Maitland

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Lecture overview

Severe anaemia is common and life-threatening cause of admission in children in sub-Saharan Africa(sSA) ~ 10% will die in hospital, and ~ 12% die 6 months post-discharge l. Whilst blood transfusions are an important treatment for severe anaemia,  scientific evidence to guide doctors on how much blood to give children, or which children require it is poor.

The TRACT trial showed that children with complicated severe anaemia (Hb <4g/dl or 4-6g/dl with severity signs) who do not have a fever require a larger volume of blood transfusion (30mls/kg whole blood) than current WHO guidelines recommend- halving mortality. Conversely, children with a high temperature, guideline-recommendations (20mls./kg) are correct.

The TRACT trial also showed that children with uncomplicated severe anaemia (no severity signs, haemoglobin 4-6g/dl) 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.

Learning Objectives:
By the end of this lecture, the attendee will be able to:

  1. Discuss why transfusion guidelines in Africa differ from high-income countries. 
  2. Explore the safety of whole blood versus packed cells. 
  3. Explore the impact of donor blood age (time from collection to transfusion) on outcomes. 
  4. Understand the burden of Sickle Cell Disease on the blood transfusion services in Africa. 
  5. Discuss the impact of severe anaemia on African children and the ensuing risk of heart failure. 

This lecture is equal to 1 CE Contact Hour, 1 CPD Hour, and 1 AMA PRA Category 1 Credit


Additional CME Info

Release Date: February 1, 2020, Termination Date: January 31, 2023

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of EB Medicine and Continulus. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: EB Medicine designates this internet enduring material for a maximum of 1 AMA PRA Category 1 Credit™ per lecture. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Commercial Support: This activity received no commercial support.

Earning Credit: In order to earn CME credit, the participant must take the pre-test, listen to the lecture, take the CME post-test, and complete the post-test evaluation.

Duration 1 hour(s).

Lecture speaker

Professor Kathryn Maitland

Kathryn Maitland is a Professor of Paediatric Tropical Infectious Diseases at the Faculty of Medicine and Director of the ICCARE Centre at the Global Centre of Health Innovation, Imperial College, London and an Honorary Fellow at MRC Clinical Trials Units, University College, London. 

Over the last 20 years, Prof. Maitland has been based full-time at the East Africa, where she leads a research group that has highlighted the unique importance of emergency-care research as a highly targeted and cost-effective means of tackling childhood mortality in resource-limited sub-Saharan Africa. Her major research portfolio includes severe malaria, bacterial sepsis and severe malnutrition. 

 As a Clinical Investigator, Prof. Maitland’s work has focused upon understanding the pathophysiology and conducting clinical trials of emergency interventions to improve outcome. To enable such translational research to occur, she has built up a network of African sites and collaborations spanning the globe bringing sophisticated technologies to apply them in real life circumstances to study common diseases of Africa.


CME Faculty Disclosure: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The speaker did not report any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.