Haemodynamic effects of erythrocyte transfusion in preterm infants

Abstract

the data suggest that although a red cell transfusion of 10 ml/kg may marginally improve peripheral perfusion, it does not influence cardiac output and arterial blood pressure in normotensive preterm infants. It may, however, cause a transient decrease in oxygen saturation.

Myocardial Adaptation to Anemia and Red Blood Cell Transfusion in Premature Infants Requiring Ventilation Support in the 1st Postnatal Week

“…Pulmonary vasodilatation in the early neonatal period may also be insufficient to compensate the increased blood viscosity after transfusion, resulting in pulmonary hypertension and a fall in pulmonary blood flow [32,33] . In this study, no decrease in oxygen saturation was noted and no adjustment in the mean airway pressure was necessary during or immediately after transfusion, suggesting a lower risk of altered pulmonary mechanics when transfusion is given for the correction of a true anemia rather than for the automatic replacement of blood losses [11] . A significant decrease in the oxygenation index was observed 48 h following transfusion, which confirmed the short-term improvements in oxygenation suggested by James et al [10] .…”

“…Measurements of cardiac output and blood pressure have been the main tools to assess the changes in systemic hemodynamics with transfusion. Using echocardiography, Leipälä et al [11] observed no variation in LV performance indexes 1 h following a 10 ml/kg packed donor red cell transfusion in very preterm infants during the first days after birth. The marked difference in the degree of anemia between the study of Leipälä et al [11] and our own probably explains the higher LV output of the anemic infants in our population.…”

“…Using echocardiography, Leipälä et al [11] observed no variation in LV performance indexes 1 h following a 10 ml/kg packed donor red cell transfusion in very preterm infants during the first days after birth. The marked difference in the degree of anemia between the study of Leipälä et al [11] and our own probably explains the higher LV output of the anemic infants in our population. The effectiveness of cardiac output adaptation in attenuating the effects of red blood cell mass variations on systemic oxygen carrying capacity has already been demonstrated in preterm infants by Pladys et al [25] .…”

“…The short-term respiratory risks of RBCT in preterm infants have been attributed to a rapid plasma transfer to the extravascular space through leaky pulmonary capillaries [34] , leading to impairment in pulmonary mechanics [35] and a transient decrease in oxygen saturation [11] . Pulmonary vasodilatation in the early neonatal period may also be insufficient to compensate the increased blood viscosity after transfusion, resulting in pulmonary hypertension and a fall in pulmonary blood flow [32,33] .…”

“…Two previous studies focused on the response to transfusion alone in nonanemic, critically ill, preterm infants. Although an improvement in different indexes of oxygenation was observed 12-24 h after transfusion in mechanically ventilated preterm infants [10] , a transient decrease in oxygen saturation, no effect on cardiac output, and only a marginal improvement in peripheral perfusion were more recently reported in comparable conditions [11] . Several factors could explain these conflicting results on oxygenation and the mixed effects on hemodynamics, particularly the absence of true anemia and the lack of a control group in both studies.…”