title: Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: an open-label single-arm trial.
abstract: BACKGROUND
  In sub-Saharan Africa, children are frequently admitted with severe anaemia needing an urgent blood transfusion, but blood is often unavailable. When conventional blood supplies are inadequate, allogeneic umbilical cord blood could be a feasible alternative. The aim of this study was to assess the safety and efficacy of cord blood transfusion in children with severe anaemia.
  
  
  METHODS
  Between June 26, 2007, and May 20, 2008, 413 children needing an urgent blood transfusion were admitted to Kilifi District Hospital in Kenya. Of these, 87 children were eligible for our study--ie, younger than 12 years, no signs of critical illness, and haemoglobin 100 g/L or lower (if aged 3 months or younger) or 40 g/L or lower (if older than 3 months). Cord blood was donated at Coast Provincial General Hospital, Mombasa, and screened for transfusion-transmitted infections and bacterial contamination. Red blood cells were stored vertically at 2-6°C to enable sedimentation. After transfusion, children were monitored closely for adverse events and followed up for 28 days. The primary outcome measure was the frequency and nature of adverse reactions associated with the transfusion. Secondary outcomes were the changes in haemoglobin concentrations 24 h and 28 days after transfusion, compared with pretransfusion levels. This trial is registered on ISRCTN.com, number ISRCTN66687527.
  
  
  RESULTS
  Of the 87 children eligible for the study, cord blood was unavailable for 24, six caregivers declined consent, and two children were withdrawn before transfusion. Therefore, 55 children received umbilical cord red blood cells from 74 donations. Ten (18%) children had ten serious adverse events and 43 (78%) had 94 adverse events; the most frequent adverse events were anaemia (n=14), weight loss (n=12), and vomiting (n=10). An independent expert panel judged none of these adverse events to be probably or certainly caused by the cord blood transfusion (one-sided 97·5% CI 0-6·5). Haemoglobin increased by a median of 26 g/L (IQR 21-31) 24 h after transfusion and by 50 g/L (10-68) a median of 29 days (28-35) after transfusion.
  
  
  CONCLUSIONS
  These preliminary data suggest that cord blood could be an important supplementary source of blood for transfusion in children in sub-Saharan Africa. Further studies are needed to compare the safety and efficacy of cord blood with conventional adult-donated blood for transfusions. Challenges associated with cost, infrastructure, and scale up also need investigating.
  
  
  BACKGROUND
  Wellcome Trust.
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya; Liverpool School of Tropical Medicine, Liverpool, UK. Electronic address: ohassall@gmail.com.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hassall
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya.
authors.forename: Johnstone
authors.initials: J
authors.lastname: Thitiri
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Greg
authors.initials: G
authors.lastname: Fegan
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya.
authors.forename: Fauzat
authors.initials: F
authors.lastname: Hamid
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya.
authors.forename: Salim
authors.initials: S
authors.lastname: Mwarumba
authors.affiliation: Coast Provincial General Hospital, Mombasa, Kenya.
authors.forename: Douglas
authors.initials: D
authors.lastname: Denje
authors.affiliation: Regional Blood Transfusion Centre, Mombasa, Kenya.
authors.forename: Kongo
authors.initials: K
authors.lastname: Wambua
authors.affiliation: Coast Provincial General Hospital, Mombasa, Kenya; Regional Blood Transfusion Centre, Mombasa, Kenya.
authors.forename: Kishor
authors.initials: K
authors.lastname: Mandaliya
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics, Imperial College London, London, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Imelda
authors.initials: I
authors.lastname: Bates
mesh_terms: D000740:Anemia / Q000628:therapy*; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D005260:Female; D005312:Fetal Blood / Q000637:transplantation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008297:Male