Maitland K, Kiguli S, Olupot-Olupot P, et al. - Through a factorial, open-label, randomized, controlled trial involving 1,565 children, researchers ascertained whether there exist a need for immediate transfusion in African children with uncomplicated severe anemia. Study participants were randomized to either the immediate-transfusion group (n = 778) or to the control group (n = 787); 984 children had malaria. During the primary hospitalization, all children in the immediate-transfusion group received transfusions; in the control group, only 49% received transfusions. In the immediate-transfusion and control groups, the mean total blood volume transfused per child was 314 ± 228 mL and 142 ± 224 mL, respectively. By 28 days, death had occurred in 7 and 13 children in the immediate-transfusion and control groups, respectively. By 180 days, death had occurred in 35 and 47 children in the immediate-transfusion and control groups, respectively—without evidence of interaction with other randomizations or proof of between-group variations in readmissions, serious adverse events, or hemoglobin recovery at 180 days. In the control group, the mean length of hospital stay was 0.9 days longer. Therefore, between the children who received immediate transfusion and those who did not, no evidence of variations in clinical outcomes over 6months was concluded. Moreover, the triggered-transfusion strategy in the control group led to lower blood use; nevertheless, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring.