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

Gamma, Edmund F. La; Krauss, Alfred N.; Auld, Peter A. M.

doi:10.1136/fn.75.2.f87

Cited by 9 publications

(8 citation statements)

References 48 publications

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“…[16] This agrees with a previous study that suggests that packed RBCs increase regional oxygen delivery and tissue surface pH. [17] This was relevant clinically in our study when we observed a statistically significant decrease in the heart rate of our infants after transfusion, suggesting that this decrease in heart rate was most probably explained by the migitation of tissue hypoxia and concomitant tachycardia. [18]…”

Section: Discussionsupporting

confidence: 93%

Red blood transfusion in preterm infants: changes in glucose, electrolytes and acid base balance

Abdelghaffar

Mansi

Ibrahim

et al. 2012

Asian J Transfus Sci

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Background:Preterm neonates comprise the most heavily transfused group of patients, and about 85% of extremely low birth weight newborns receive a transfusion by the end of their hospital stay. The aim of this study was to assess the possible metabolic effects of RBC transfusion on preterm infants, especially during the first 2 weeks of life, and its relation to blood volume.Materials and Methods:This study was conducted on 40 preterm neonates with gestational age of less than or equal to 34 weeks. They received RBCs transfusion during first 2 weeks of life. Venous blood samples of infants were collected 2 to 4 hours before and 1 hour after the end of transfusion to evaluate hemoglobin (Hb) level, hematocrit, acid-base, electrolytes, and glucose status. Then, infants were classified into two main groups: those who received RBCs volume less than or 20 ml/kg and those who received RBCs volume more than 20 ml/kg.Results:Infants received a mean volume of 20.38 ± 3.2 ml/kg RBCs (range, 10.9 - 26.6 ml/kg) at a median age of 9.8 ± 3.6 days. After transfusion, a significant increase of mean Hb (P<0.001), mean Hct (P<0.001), pH (P<0.001), pO2 (P<0.05), and a significant decrease of the pCO2 (41.46 ± 8.8torr vs 35.4 ± 9.34 torr; P<0.001) were observed. In addition, there was a significant increase of serum K+ (P<0.001), and a significant decrease of Ca+2 (P<0.001). A positive correlation was found between the K+ intake and the changes of kalemia (r = 0.99; P = 0.00). Furthermore, we observed an inverse correlation between the patients’ calcium intake and the changes of calcemia (r = -0.35; P = 0.02). On comparing the changes in clinical and biochemical variables between two groups after transfusion, we observed a significant increase in mean Hb and Hct associated with a significant decrease in mean serum Ca+2 (P<0.001) in the group receiving the larger blood volume.Conclusion:RBC transfusion was effective in improving anemia, oxygenation, increasing pH, and decreasing CO2 and Ca+2. However, from a more clinically relevant point of view, we demonstrated the development of hyperkalemia, especially in infants with a previously borderline hyperkalemia.

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Section: Discussionsupporting

confidence: 93%

Red blood transfusion in preterm infants: changes in glucose, electrolytes and acid base balance

Abdelghaffar

Mansi

Ibrahim

et al. 2012

Asian J Transfus Sci

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“…In a related study that directly assessed regional O 2 utilization and muscle metabolism, tissue pH improved after pRBC transfusion without altering peripheral blood flow consistent with improved O 2 delivery due to augmented RCM and O 2 content [29]. In contrast, tissue pH did not change after equivalent volumes of colloid infusion supporting the contention in the current report that these effects emerge from changes in hemoglobin and not from blood volume expansion per se [29].…”

Section: Discussionsupporting

confidence: 78%

“…Given this observed response to "booster" transfusion, it appears that real-time rSO 2 and FTOE monitoring revealed a reversible subclinical departure in the balance of oxygen delivery-to-consumption following quantitative iatrogenic phlebotomy in these patients before manifestation of any systemic clinical signs (e.g., tachycardia, metabolic acidosis, etc.) [4,20,29].…”

Section: Discussionmentioning

confidence: 99%

Monitoring regional tissue oxygen extraction in neonates <1250 g helps identify transfusion thresholds independent of hematocrit

Mintzer

Parvez

Chelala

et al. 2014

Journal of Neonatal-Perinatal Medicine

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OBJECTIVE: We sought to characterize the effects of "booster" packed red blood cell transfusions on multisite regional oxygen saturation in very low birth weight neonates during the first postnatal week and to examine the utility of fractional tissue oxygen extraction as an estimate of tissue oxygenation adequacy. STUDY DESIGN: Data were collected in an observational near-infrared spectroscopy (NIRS) pilot survey of 500-1250 g neonates during the first postnatal week. A before-after analysis of "booster" transfusions, defined as empiric 15 mL/kg transfusion following 10 mL/kg cumulative phlebotomy losses, was conducted upon cardiopulmonary, laboratory, and spectroscopy data. RESULT: Ten neonates (gestational age 26 ± 0 wk; birth weight 879 ± 49 g) received 14 transfusions at 3 ± 0 postnatal days. Mean hematocrit increased from 35.2 ± 1.2 to 38.5 ± 1.2 % (P < 0.05) following transfusion; pH, base deficit, lactate, creatinine, and cardiopulmonary parameters were unchanged. Cerebral, renal, and splanchnic tissue oxygenation increased 10, 18, and 16%, with concomitant decreases in calculated oxygen extraction of 27, 30, and 9% (all P < 0.05), consistent with enhanced tissue oxygenation. These findings were not observed in a non-transfused comparison group of nine patients. CONCLUSION: "Booster" transfusions improved indices of regional tissue oxygenation while no departures were observed in conventional cardiovascular assessments. We speculate that NIRS-derived oxygenation parameters can provide an objective, graded, and continuous estimate of oxygen delivery-consumption balance not evident using standard monitoring techniques.

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“…The failure to identify a change in the hematocrit is likely a result of our practice of administering booster-packed red-cell transfusions to all oxygen requiring ventilated patients to maintain their hematocrits at or approximately 40%. 40,41 Although, the changes in the absolute monocyte and lymphocyte counts were statistically significant at the 7-to 10-day point, they always remained within the range of published normal values. 36 No adverse effects could be attributed to these unintended study drug responses.…”

Section: Discussionmentioning

confidence: 75%

Human Granulocyte Colony-stimulating Factor May Improve Outcome Attributable to Neonatal Sepsis Complicated by Neutropenia

Kocherlakota

Gamma

1997

Pediatrics

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ABSTRACT. Objectives. To determine whether adjunctive therapy with recombinant human granulocyte colony-stimulating factor (rhG-CSF) could reverse sepsis-associated neonatal neutropenia and improve neonatal survival compared with conventional therapy in a phase I/II-type trial.Study Design. An intravenous infusion of rhG-CSF (10 g/kg/d ؋ 3 d) was administered to 14 septic neutropenic neonates. Neutrophilic responses and outcome of these neonates were compared with 11 concurrently treated, retrospectively selected, case-matched control septic patients identified by using a search of medical records coded for sepsis with neutropenia ( 24 hours).Results. Seven neonates with early-onset sepsis with neutropenia at birth and seven neonates with late-onset sepsis plus neutropenia (all with necrotizing enterocolitis) were entered in the rhG-CSF treatment group. Results were compared with a conventional therapy control group (five early onset, six late onset). No significant differences existed in the birth weight, gestational age, use of antibiotic therapy, magnitude of respiratory support, severity of metabolic acidosis, use of vasopressors, or other supportive therapy between the two groups. In the rhG-CSF-treated group and in the conventionally treated control group, the absolute neutrophil count (ANC) (mean ؎ SEM) was 585 ؎ 138 and 438 ؎ 152, respectively. The ANC increased to more than baseline in the rhG-CSF-treated group by 10-fold versus 2-fold at 24 hours, 18-fold versus 4-fold at 48 hours, 24-fold versus 5-fold at 72 hours (significant by one-way analysis of variance in the rhG-CSF group only), and 29-fold versus 16-fold at 7 to 10 days when compared with the conventional therapy group. There were no nonresponders in the rhG-CSF group by 24 hours after the first dose of study drug. Monocyte cell counts also increased significantly in both groups by 7 days after entry into this protocol but remained within normal range for age. No clinically significant effect on lymphocytes, erythrocytes, or platelet counts was noted. Thirteen patients in the rhG-CSF-treated group (92%; 13 out of 14) and five in the conventionally treated group (55%; 5 out of 11) survived to 28 days after the onset of the signs of sepsis. No adverse effects were noted in the rhG-CSF-treated group.Conclusions. rhG-CSF can increase the neutrophil count in critically ill septic neutropenic neonates. This finding suggests that rhG-CSF may be effective in a therapeutically useful time frame to treat septic neonates with neonatal neutropenia attributable to bone marrow suppression or neutrophil consumption. Future randomized trials are needed to validate the beneficial effects of rhG-CSF and to determine whether any significant side effects of therapy exist. Pediatrics 1997;100(1). URL: http: //www.pediatrics.org/cgi/content/full/100/1/e6; neonatal sepsis, recombinant human granulocyte colony stimulating factor, bacteremia, cytokines, very low birth weight, neutropenia.

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

Cited by 9 publications

References 48 publications

Red blood transfusion in preterm infants: changes in glucose, electrolytes and acid base balance

Red blood transfusion in preterm infants: changes in glucose, electrolytes and acid base balance

Monitoring regional tissue oxygen extraction in neonates <1250 g helps identify transfusion thresholds independent of hematocrit

Human Granulocyte Colony-stimulating Factor May Improve Outcome Attributable to Neonatal Sepsis Complicated by Neutropenia

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