Why have you included children with a low haemoglobin (<5g/dl)?
Often children with severe anaemia and respiratory distress die whilst awaiting the arrival of an emergency transfusion. We have shown in a small pilot study that children given pre transfusion management with a bolus of saline or albumin were no worse off than if left waiting for a transfusion without pre-transfusion management. Indeed significant clinical improvements were observed even prior to transfusion. As this is a pragmatic trial and fluid interventions would be given whilst blood test results awaited these cases were also included. Moreover, significant delays would be encountered if enrolment were consequent upon the laboratory results. Volume replacement whilst awaiting emergency blood transfusion is recommended by the WHO for every other indication/group and information obtained about this important subgroup in the FEAST trial would generate important evidence to support the basis for acute transfusion practice guidelines.
