Cytokine Load in Prestorage Leukoreduced PRBC Transfusions in Premature Infants

Locke, Robert; Paul, David A.; Touch, Suzanne M.; Mackley, Amy; Maduskuie, Victoria; Fawcett, Paul T.

doi:10.1038/sj.jp.7211340

Cited by 20 publications

(27 citation statements)

References 25 publications

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“…The increases in IL-1β, IL-8, TNF-α, and MCP-1 observed after transfusion in convalescing preterm infants correlated with increases in markers of endothelial activation, principally sICAM-1 and MIF. This proinflammatory reaction may be a manifestation of TRIM, not previously reported in the preterm infant (14), and may partly explain the association between PRBC transfusion and the pathogenesis of several neonatal morbidities affecting the brain, lung, and gut.…”

Section: Discussionmentioning

confidence: 85%

Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant

et al. 2012

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Background: Transfusion of packed red blood cells (PRBcs) saves lives in the neonatal critical care setting and is one of the most common interventions in the preterm infant. The number and volume of PRBc transfusions are associated with several major neonatal morbidities, although a direct causal link between transfusion and major neonatal morbidity is still to be proven. Transfusion-related immunomodulation (TRIM) may underlie these adverse outcomes, yet it has received little attention in the high-risk preterm infant. Methods: One transfusion event was studied in infants ≤28 wk gestation between 2 and 6 wk postnatal age (n = 28). Plasma inflammatory cytokines and markers of endothelial activation were measured in the infants before and 2-4 h after transfusion, as well as in the donor pack. results: Median (range) age at transfusion was 18 (14-39) days with the pretransfusion hemoglobin level at 9.8 (7.4-10.2) g/dl. Interleukin (IL)-1β (P = 0.01), IL-8 (P = <0.001), tumor necrosis factor-α (P = 0.008), and monocyte chemoattractant protein (P = 0.01) were increased after transfusion. a similar elevation in markers of endothelial activation was seen after transfusion with increased plasma macrophage inhibitory factor (P = 0.005) and soluble intracellular adhesion molecule-1 (P = <0.001). conclusion: Production of inflammatory cytokines and immunoactivation of the endothelium observed after the transfusion of PRBcs in the preterm infant may be a manifestation of TRIM. The implications of this emerging phenomenon within the preterm neonatal population warrant further investigation. t ransfusion of blood products is not benign. In adults, transfusion is an independent predictor of death and is associated with an increased incidence of multiorgan system failure, length of hospital stay, infection risk, and modulation of the immune system (1,2). Although the mechanisms underlying these associations are yet to be comprehensively characterized, a two-hit model of posttransfusion injury has been proposed (3). In the clinical setting of an underlying inflammatory state priming the recipient's immune system, transfusion of packed red blood cells (PRBCs) may trigger immune cell activation and related immunomodulation, resulting in frank inflammation (4). This transfusion-related immunomodulation (TRIM), encompassing not only adverse proinflammatory and immunosuppressive responses but also the whole spectrum of posttransfusion effects on organs and tissues, has been proposed to underlie much of the increased transfusionassociated morbidity and mortality seen in adults (4).In the neonatal population, there is an increasing awareness of the excess morbidity and mortality associated with PRBC transfusions (5,6). PRBC transfusions have been implicated in the development of problems not encountered in the adult population, including chronic lung disease (7), retinopathy of prematurity (8), and necrotizing enterocolitis (9,10), with the incidence and severity of these conditions correlating with the number and volume of PRBC tran...

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Section: Discussionmentioning

confidence: 85%

Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant

et al. 2012

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“…Our previous research has shown no systemic cytokine response after PRBC transfusion. 16 However, because intestinal ischemia is part of the pathophysiology of NEC, any inflammatory response after transfusion may be initially limited to the intestine. TRALI can be immune mediated and non-immune mediated.…”

Section: Discussionmentioning

confidence: 99%

Increased Odds of Necrotizing Enterocolitis After Transfusion of Red Blood Cells in Premature Infants

et al. 2011

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“…28,29 However, when RBCs are leukoreduced before storage, the relationship between the age of RBCs and the expression of pro-inflammatory cytokines disappeared. 16,30 As the RBCs used in this study series were leukoreduced, the age of transfused units, as expected, did not differ between cases and controls.…”

Section: Transfusion Feeding and Nec M El-dib Et Almentioning

confidence: 95%

Red blood cell transfusion, feeding and necrotizing enterocolitis in preterm infants

et al. 2011

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Objective: Preliminary studies suggested an association between red blood cell (RBC) transfusion and necrotizing enterocolitis (NEC) in premature neonates. An advantageous effect of withholding feeds during transfusion has never been studied. We aimed, first, to determine whether preterm infants who developed NEC were more likely to be transfused in the 48 to 72 h before the diagnosis of NEC; second, to test if a strict policy of withholding feeds during transfusion would decrease the incidence of transfusion-associated NEC.Study Design: The study was conducted in two phases. Phase 1: a retrospective case-control study of premature low-birth weight (<32 weeks and <2500 g) infants who developed NEC over a 6-year period. Phase 2: a comparison study of the incidence of NEC during the 18-months preceding, and the 18 months following the change of practice to withholding feeds during RBC transfusion.Result: In the case-control study (25 infants with NEC and 25 controls), more infants in the NEC group received transfusions in the 48 and 72 h preceding diagnosis (56 vs 20% within 48 h, P ¼ 0.019; and 64 vs 24% within 72 h, P ¼ 0.01). The total number of transfusions and age of RBCs were not different between the two groups. Implementing the policy of withholding feeds during transfusion was associated with a decrease in the incidence of NEC from 5.3 to 1.3% (P ¼ 0.047). Conclusion:Infants who developed NEC frequently received RBC transfusions in the 48 and 72 h preceding presentation of NEC. A strict policy of withholding feeds during transfusion may have a protective effect from NEC.

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Cytokine Load in Prestorage Leukoreduced PRBC Transfusions in Premature Infants

Cited by 20 publications

References 25 publications

Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant

Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant

Increased Odds of Necrotizing Enterocolitis After Transfusion of Red Blood Cells in Premature Infants

Red blood cell transfusion, feeding and necrotizing enterocolitis in preterm infants

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