Determination of Red-Cell Mass in Assessment and Management of Anaemia in Babies Needing Blood Transfusion

Phillips, Helen; Abdel-Moiz, Abdel; Jones, J.G.; Wardrop, CharlesA.J.; Holland, B M; Fayed, Suheir; Turner, Thomas L.; Cockburn, F.

doi:10.1016/s0140-6736(86)90988-8

Cited by 50 publications

(39 citation statements)

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“…Brans et al (27) observed no alterations after intrauterine growth deviations in the plasma and blood volumes in appropriately grown, growth-retarded and macrosomic full or near-term polycythemic infants studied within 32 h of birth. The Hb subtype method allows RCV and BV assessment in any newborn requiring a red cell transfusion (8). Analogously to their postnatal profile of LVO, the SGA infants failed to increase their blood volume during the first days of life.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac Hypertrophy and Altered Hemodynamic Adaptation in Growth-Restricted Preterm Infants

et al. 2003

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The objective was to elucidate hemodynamic adaptation in very low birth weight (Ͻ1500 g) infants after intrauterine growth retardation. 31 growth-retarded (SGA, birth weight Ͻ-2 SD) and 32 appropriate for gestational age (AGA, birth weight within Ϯ 1 SD range) infants were enrolled. In SGA infants, the diastolic diameters of the interventricular septum and the left ventricle were increased, and serum brain natriuretic peptide (BNP) was elevated. Left ventricular output (LVO) of the AGA infants increased from 150 Ϯ 28 to 283 Ϯ 82 mL/kg/min during the study (p Ͻ 0.01). The SGA infants had a higher initial LVO than the AGA infants (243 Ϯ 47 versus 150 Ϯ 28 mL/kg/min, p Ͻ 0.05), but did not show further LVO increase during the study period. Red cell (RCV) and blood (BV) volume were assessed by Hb subtype analysis, when packed donor red cells were transfused. RCV and BV did not differ between the groups initially, but RCV increased by 18% and BV by 29% in the AGA group during the first 3 d. On day 3, AGA infants had larger BV than the SGA infants (88 Ϯ 5 versus 73 Ϯ 12 mL/kg, p Ͻ 0.05). In conclusion, cardiac hypertrophy, elevated initial LVO and BNP of the SGA infants suggest increased cardiac workload after intrauterine growth retardation. Based on the BV and RCV data, blood volume regulation may also be impaired. The data suggest that SGA preterm infants may be exposed to an increased risk of circulatory failure during early adaptation. Intrauterine growth retardation is associated with increased neonatal mortality, perinatal complications and long-term neurologic sequelae in preterm infants (1), as well as compromised cardiovascular adaptive capacity already in utero (2-4). However, few data have been reported regarding early circulatory adaptation after intrauterine growth retardation. In addition to myocardial performance, adequate intravascular volume is essential for successful postnatal cardiovascular adaptation. Largely due to the lack of applicable methodology, present knowledge on intravascular volume of preterm infants in general is scarce, and the effect of growth retardation on circulating volume has not been studied.The aim of the present study was to test the hypothesis that fetal growth retardation alters the pattern of early hemodynamic adaptation of very low birth weight infants. During the first two weeks of life, left ventricular function and dimensions were assessed by echocardiography in SGA infants and AGA control infants. A circulating indicator of ventricular dysfunction, BNP, was also measured. RCV and BV were determined by a method based on dilution of autologous HbF by donor HbA when red cells were transfused based on clinical judgment. Hemodynamic evaluation was also performed by using indirect indices applied in routine clinical work. METHODS Patients.All infants in the study were born in the maternal unit of the Helsinki University Hospital and treated in the

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Section: Discussionmentioning

confidence: 99%

“…The volume assessment was performed by a modification of the Hb subtype method described by Phillips et al (8). An arterial blood sample was drawn before transfusion (immediately after echocardiography), and 15 min after the transfusion.…”

Section: Patientsmentioning

confidence: 99%

Cardiac Hypertrophy and Altered Hemodynamic Adaptation in Growth-Restricted Preterm Infants

et al. 2003

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“…We have found monitoring changes in optical density at this wavelength, an approximately 10-fold increase in sensitivity over monitoring at 542 nm. Calculation of the %HbF by computer analysis was as described previously (9). (CV for test using 1.5 x lo5 cells = 6.73%.)…”

Section: V)mentioning

confidence: 99%

Definitive Estimate of Rate of Hemoglobin Switching: Measurement of Percent Hemoglobin F in Neonatal Reticulocytes

et al. 1988

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HbF, optimal for oxygen transport in utero, is progressively replaced by HbA from about 32-36 wk of gestation (1). This maturational phenomenon is clinically important and shows marked individual variation. Prolonged postnatal dependence on HbF impairs oxygen transport and has been associated with clinicallv significant anaemia and with the sudden infant death on acid elution (5), and on indirect mathematical analysis of circulating fetal and adult Hb (6, 7). Studies of Hb actively synthesized by reticulocytes in vitroimply a gradual decline of HbF synthesis after a sigmoid curve, the "steep" part starting at about 32 wk gestation and proceding such that the "half-time" for 50% reduction in HbF synthesis is >6 wk. There is a corresponding increase in HbA production. This technique, which assesses HbF/A synthetic balance at the end of erythroid maturation in vitro, may not accurately reflect events in vivo.Studies using the acid elution method of Betke and Kleihauer for detecting HbF in erythrocytes point to the sudden appearance of a distinct subpopulation of cells containing predominantly HbA at about the time of resumption of erythropoiesis after the postnatal erythropoietic shut-down. This suggests a fairly rapid process followed by the appearance of a new population of erythroid cells containing HbA (1, 5).A similiar pattern can be inferred from mathematical analyses of the changing proportion of HbF and HbA in the circulation of individual infants studied postnatally. Mathematical analyses could be taken to imply that, on resumption of erythropoiesis after the postnatal shut-down, HbF synthesis has completely ceased (6, 7). The histo-chemical and mathematical findings could be reconciled with the in vitro observations by assuming that the switchover occurs gradually during a period of relatively inactive erythropoiesis and that, when erythropoiesis resumes, any residual HbF synthesis is insufficient to be detected by these techniques. However, this hypothesis has not been proven and the controversy between rapid and slower rates of switching has not yet been satisfactorily resolved.The discrepancies relating to the time course of the switching process prompted us to develop a direct means of assessing HbF to HbA switching patterns in infants by measurement of the %HbF in reticulocytes harvested from the peripheral blood at different postconceptual stages. We consider that the %HbF of reticulocytes accurately reflects the balance of HbF/A synthesis in the bone marrow in the 2-3 days immediately preceding sampling. This direct approach overcomes the shortcomings associated with the indirect nature of the previous studies. syndroie T2, 3). Despite its biological importance the time course of switching has remained controversial (1). There are PATIENTS theoretical reservations about the validity of methods previously used to study Hb switching. These depend respectively on in Thirty preterm infants of gestation at birth 26-33 wk (mean vitro globin chain synthesis (4), on histochemical studies based 29.5 + 1.74 ...

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“…Consequently, the calculation of the FPV by using the post-transfusion Ht within a changing total blood volume leads to an incorrect and under-estimated feto-placental blood volume 5 . In infants needing blood transfusion, both post-as well as the pre-transfusion Ht values may be unreliable because of fluctuations in the intravascular plasma volume 6,7 . Instead of Ht values, it is advised to use different red cell markers for the donor cells and those of the newborn.…”

Section: Introductionmentioning

confidence: 99%

A new method to determine the feto-placental volume based on dilution of fetal haemoglobin and an estimation of plasma fluid loss after intrauterine intravascular transfusion

Hoogeveen¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Determination of Red-Cell Mass in Assessment and Management of Anaemia in Babies Needing Blood Transfusion

Cited by 50 publications

References 7 publications

Cardiac Hypertrophy and Altered Hemodynamic Adaptation in Growth-Restricted Preterm Infants

Cardiac Hypertrophy and Altered Hemodynamic Adaptation in Growth-Restricted Preterm Infants

Definitive Estimate of Rate of Hemoglobin Switching: Measurement of Percent Hemoglobin F in Neonatal Reticulocytes

A new method to determine the feto-placental volume based on dilution of fetal haemoglobin and an estimation of plasma fluid loss after intrauterine intravascular transfusion

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