Chintoloa, Elizabeth;
Connon, Roisin;
George, Elizabeth;
Chagaluka, George;
M'baya, Bridon;
Walker, Sarah;
Kennedy, Neil;
(2025)
Cardiac Output Measurement in Malawian children aged 2 months to 12 years hospitalised with severe anaemia (COM-TRACT).
International Health
(In press).
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Text (Accepted Manuscript)
COMTRACT_accepted26thAug2025.pdf - Accepted Version Access restricted to UCL open access staff until 14 February 2026. Download (2MB) |
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Text (Supplemental Files)
Supplemental FilesCOMTRACT.docx - Accepted Version Access restricted to UCL open access staff until 14 February 2026. Download (19kB) |
Abstract
Background: Little is known about myocardial perturbations in African children hospitalised with severe anaemia. / / Methods: An observational study nested within a clinical trial of blood transfusion conducted on the paediatric ward, Blantyre, Malawi. Children were aged 2 months to 12 years hospitalized with severe anaemia (haemoglobin 4–6 g/dl). By randomisation, 13 children received 30 mls/kg whole blood; 13 received 20 mls/kg whole blood; and 26 had no immediate transfusion (usual care). Standard parameters of cardiac function were measured using Ultrasonic Cardiac Output Monitoring at enrolment, 8 hours, 24 hours, and discharge. / / Results: Fifty-two children, median age 39 months (IQR 25–58) and median haemoglobin 5.1 g/dl (4.8–5.6), were studied. Severe tachycardia and tachypnoea corrected faster in the transfused arms than in the control. At enrolment, stroke volume index was within the normal range; 26/52 (50%) had cardiac output index (COI) > 97.5% standard centile. COI reduced in all arms by discharge but was greatest in the transfusion arms (p=0.05 for 20 mls/kg and p=0.009 for 30 mls/kg). A higher volume or receipt of whole blood did not worsen cardiac function. No child required diuretics. / / Conclusions: The data generated by this small but granular study of haemodynamic and cardiac function provide reassuring physiological evidence that higher doses of blood transfusion than currently recommended are safe. These findings support secondary analyses of the TRACT trial indicating the safety of whole blood transfusions and reinforce the new evidence-based paediatric transfusion algorithm for anaemic African children.
| Type: | Article |
|---|---|
| Title: | Cardiac Output Measurement in Malawian children aged 2 months to 12 years hospitalised with severe anaemia (COM-TRACT) |
| Publisher version: | https://academic.oup.com/inthealth |
| Language: | English |
| Additional information: | This version is the author-accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10212883 |
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