The effect of blood storage age on treatment of lactic acidosis by transfusion in children with severe malarial anaemia: a pilot, randomized, controlled trial
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Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
Malaria Journal
Abstract
Severe malarial anaemia requiring blood transfusion is a life-threatening condition affecting millions
of children in sub-Saharan Africa. Up to 40% of children with severe malarial anaemia have associated lactic
acidosis. Lactic acidosis in these children is strongly associated with fatal outcomes and is corrected by blood
transfusion. However, it is not known whether the storage age of blood for transfusion affects resolution of lactic
acidosis. The objective of this pilot study was to evaluate the effect of blood storage age on resolution of lactic
acidosis in children with severe malarial anaemia and demonstrate feasibility of conducting a large trial.
Methods: Children aged six to 59 months admitted to Acute Care Unit of Mulago Hospital (Kampala, Uganda) with
severe malarial anaemia (haemoglobin ≤ 5 g/dL) and lactic acidosis (blood lactate ≥5 mmol/L), were randomly
assigned to receive either blood of short storage age (one to 10 days) or long storage age (21–35 days) by gravity
infusion. Seventy-four patients were enrolled and randomized to two equal-sized study arms. Physiological
measurements, including blood lactate, oxygen saturation, haemoglobin, and vital signs, were taken at baseline,
during and after transfusion. The primary outcome variable was the proportion of children whose lactic acidosis
resolved by four hours after transfusion.
Results: Thirty-four of 37 (92%) of the children in the short storage treatment arm compared to 30/37 (81%) in the
long storage arm achieved a blood lactate <5 mmol/L by four hours post transfusion (p value = 0.308). The mean
time to lactic acidosis resolution was 2.65 hours (95% CI; 2.25–3.05) in the short storage arm, compared to
3.35 hours (95% CI; 2.60–4.10) in the long storage arm (p value = 0.264).
Conclusion: Pilot data suggest that among children with severe malarial anaemia and lactic acidosis transfused
with packed red blood cells, the storage age of blood does not affect resolution of lactic acidosis. The results
support a larger and well-powered study which is under way.
Description
Keywords
Severe malarial anaemia, Lactic acidosis, Blood storage age, Blood transfusion, Children
Citation
Dhabangi et al.: The effect of blood storage age on treatment of lactic acidosis by transfusion in children with severe malarial anaemia: a pilot, randomized, controlled trial. Malaria Journal 2013 12:55. doi:10.1186/1475-2875-12-55