Commentary on small‐volume red cell transfusions for neonatal patients

Strauss, Ronald G.; Sacher, Ronald A.; Blazina, Janice; Blanchette, Victor S.; Schloz, Lynn; Butch, Suzanne H.; Hume, Heather; Levy, Gary J.; McMican, A.; Sotelo‐Avila, Cirilo

doi:10.1046/j.1537-2995.1990.30690333489.x

Cited by 38 publications

(15 citation statements)

References 35 publications

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“…Observou-se uma estabilidade clínica, cujos critérios foram descritos em material e métodos, de todos pacientes, assim como está nas publicações da maioria dos autores [1][2][3]9,22,[27][28][29] . Apesar de alguns estudos não terem evidenciado correlação do Ht com a manifestação respirató-ria 4 , um dos critérios estabelecidos por Strauss e colaboradores 30 , em 1990, para indicar a TS seria a manutenção do Ht em 40% naqueles pacientes com doenças respiratórias. Portanto, teoricamente, caso houvesse uma diversidade clínica e ventilatória muito grande entre os grupos, como por exemplo, a presença de RNs com maior necessidade de suporte ventilatório nos grupos 1 e 2, que receberam a EPO, poderia se concluir erroneamente que a medicação testada não diminui a quantidade de TSs, pois os pacientes desses grupos teriam sido mais transfundidos, provavelmente pela maior gravidade clínica.…”

Section: Discussionunclassified

O efeito da eritropoetina humana recombinante no tratamento da anemia da prematuridade

Rocha

Benjamin²,

Procianoy³

2001

J. Pediatr. (Rio J.)

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Objective: to assess the efficacy of erythropoietin in the prevention and treatment of anemia of prematurity, correlating the use of this drug with weight gain, length, and head circumference and comparing two administration schemes of he same weekly dose: daily use and twice a week.Methods: the study comprised 42 premature newborns with gestational age up to 33 weeks, birthweight up to 1550 g, and postnatal age between 10 and 35 days. The newborns were randomized into three groups: patients in group 1 received seven daily doses of 100 U/kg erythropoietin per week; patients in group 2 received two 350 U/kg erythropoietin doses per week; and patients in group 3 did not receive the drug. Hematologic measurements, blood transfusion requirements, and growth rates were followed during therapy.Results: cases and controls did not differ with respect to weight, length, head circumference, and total time of hospital stay. At the end of the study, no significant difference was observed in the platelet count measurement means, white blood cell count, and ferritin levels in the three groups. However, the final hematocrit and hemoglobin values of patients who did not receive erythropoietin were significantly lower than those of patients who received the drug. The absolute reticulocyte count mean was significantly higher in patients who received erythropoietin after two weeks of treatment when compared with those patients who did not receive the drug. Patients in group 1 e 2 received fewer excessive transfusions (2 or more) than patients in group 3. The administration of 700 U/kg/week erythropoietin significantly reduced the number of excessive blood transfusions. There is no significant difference in blood transfusion volume between patients who received erythropoietin on a daily basis and those who received the drug twice weekly.Conclusions: the use of erythropoietin did not influence weight gain and growth. The administration of 700 U/kg/week erythropoietin in premature infants with gestational age up to 33 weeks and birthweight up to 1550 g stimulates erythropoiesis and significantly reduces excessive blood transfusion requirements. Erythropoietin showed to be a safe and well tolerated medication, with no short-term side effects in the study population.J Pediatr (Rio J) 2001; 77 (2): 75-83: erythropoietin, anemia of prematurity, transfusion, premature. ResumoObjetivos: a proposta do presente estudo foi avaliar a eficácia da eritropoetina na prevenção e tratamento da anemia da prematuridade, correlacionar o uso desta medicação com o ganho de peso, comprimento e perímetro cefálico dos pacientes. Foi realizada também uma comparação entre o uso de eritropoetina diariamente e o uso duas vezes por semana, na mesma dose semanal.Métodos: ensaio clínico que avaliou 42 recém-nascidos prematuros, com até 33 semanas de idade gestacional, peso de nascimento até 1550g e idade pós-natal entre 10 e 35 dias de vida. Os recém-nascidos foram randomizados em três grupos. Os pacientes do grupo 1 receberam 7 doses diárias, de 100U/kg c...

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Section: Discussionunclassified

O efeito da eritropoetina humana recombinante no tratamento da anemia da prematuridade

Rocha

Benjamin²,

Procianoy³

2001

J. Pediatr. (Rio J.)

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“…Banked adult blood has 2,3 diphospoglycerate (2,3-DPG) concentrations roughly equal to those circulating red cells from normal preterm neonates; concentrations subsequently increase several hours after infusion. 23 24 Consequently, we made no attempt to account for any presumptive improvement in oxygen transfer that may result from the increase in the in vivo percentage of adult haemoglobin, as our measurements were made in the first hour of monitoring immediately after the transfusion.…”

Section: Methodsmentioning

confidence: 99%

Effects of increased red cell mass on subclinical tissue acidosis in hyaline membrane disease.

Gamma

Krauss²,

Auld³

1996

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Aim-To determine whether there are subclinical deficits in oxygen delivery in ventilated premature neonates. Method-Ventilated premature neonates weighing less than 1500 g, who were transfused for anaemia or who were given colloids for clotting abnormalities (or oedema), were haemodynamically monitored during the first week of life. Calf muscle surface pH (tpH) was measured in conjunction with peripheral limb blood flow by occlusion plethysmography. Results-Packed red blood cell transfusions corrected a subclinical regional tissue acidosis (low tpH) without affecting arterial pH or limb blood flow. This observation also correlated with an increase in regional oxygen delivery. The data were also suggestive of a pattern of pathological, supply dependent, oxygen delivery and are similar to other observations made in adults with adult respiratory distress syndrome. Conclusions-Packed red blood cells increase regional oxygen delivery and tissue surface pH. In contrast, colloid infusion provided no substantial cardiovascular or metabolic benefit to these patients and should be avoided when oxygen delivery is at issue and when there may be leaky pulmonary capillaries.

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“…By 21 days of storage, 2,3-DPG is markedly diminished in both AS-1 and CPDA-1 units of PRBC. The p50 falls from approximately 27 torr in fresh blood to 18 torr at time of expiration [ 25] . However, many authors have felt that concern over 2,3-DPG for small volume transfusions is unwarranted [ 6,7,16,25] .…”

Section: Discussionmentioning

confidence: 97%

“…The p50 falls from approximately 27 torr in fresh blood to 18 torr at time of expiration [ 25] . However, many authors have felt that concern over 2,3-DPG for small volume transfusions is unwarranted [ 6,7,16,25] . A p50 of 18 torr is comparable to the level found in the red blood cells of many premature infants at birth [ 26] .…”

Section: Discussionmentioning

confidence: 97%

Metabolic Consequences in Very Low Birth Weight Infants Transfused With Older as-1-Preserved Erythrocytes

Goodstein¹

1998

Pediatric Pathology & Molecular Medicine

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Janis F. Smith, MAS, MT (ASCP)Red Cross Blood Service, SBB u A merican Greater Chesapeake and Potomac Region, Baltimore, M aryland, USA S. David Rubenstein,and Children's Hospital of N ew Y ork, N ew MD u Babies Y ork, USA study evaluated the biochemical and physiologic changes in extremely premature inf ants recei-u Our ving AS-1-preserved packed red blood cells ( PRBC) stored 5 to 21 days, including increase in hemoglobin, maintenance of eug lycemia, and normal serum potassium levels, acid-base balance, and urine output. T welve inf ants ( birth weight 775 6 127 g ) with gestational age of 25 6 1 weeks received small volume replacement transfusions with 17 mL/kg PRBC preserved in an AS-1 dedicated unit. Inf ants were monitored throughout the transfusions and blood samples were obtained pre-and postransfusion f or comparison by Student's t-test. T he inf ants remained clinically stable throughout the transfusions and had an increase in hemoglobin of 2.5 g/dL. T here was no change in urine output. Serum ammonia lactate dehydrogenase ( LD H) , and glucose levels were altered as predicted. T here were also small, but clinically insigni cant, changes in serum potassium, bicarbonate , total bilirubin, and creatinine. Eug lycemia was maintained in 84% of the transfusions. We concluded that small volume transfusions with PRBC stored up to 21 days in AS-1 can be used in the very low birth weight inf ant without apparent detriment when extensive metabolic criteria are examined.Keywords additive solution 1 ( AS-1) , dedicated unit, packed red blood cells ( PRBC) , transfusion, very low birth weight ( VLBW)

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Commentary on small‐volume red cell transfusions for neonatal patients

Cited by 38 publications

References 35 publications

O efeito da eritropoetina humana recombinante no tratamento da anemia da prematuridade

O efeito da eritropoetina humana recombinante no tratamento da anemia da prematuridade

Effects of increased red cell mass on subclinical tissue acidosis in hyaline membrane disease.

Metabolic Consequences in Very Low Birth Weight Infants Transfused With Older as-1-Preserved Erythrocytes

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