Is Lasix After a Blood Transfusion Necessary?

Abstract

necessity for the use of furosemide post-blood transfusion is necessary.To date, 3 studies have assessed the utility of furosemide post-blood transfusion. Two of the 3 studies were double-blind, randomized, placebo-controlled trials. In the first study, 20 infants born less than 28 weeks' gestation were randomized into either a placebo group or a furosemide group. 2 No differences were found between the 2 groups on the basis of neonatal characteristics. All blood transfusions (15 mL/kg over 3 hours) occurred within the first 2 weeks of life, and 12 of the 20 infants were randomized to the furosemide group (single dose, 1 mg/kg). A total of 13 clinical and ventilatory factors were collected from each infant before and after the blood transfusion. Examples of these factors include heart rate, peripheral oxygen saturation, FiO 2 , peak inspiratory pressure, and positive end-expiratory pressure. A comparison of these 13 factors between the placebo group and the furosemide group showed no statistically significant difference. A single dose of furosemide was shown not to change ventilator or clinical factors.In another double-blind, randomized, placebocontrolled trial, 40 neonates at least 7 days old and less than 37 weeks' gestation were enrolled to compare FiO 2 6 hours prior to a blood transfusion to FiO 2 levels in the 24 hours after the blood transfusion (20 mL/kg over 4 hours). 1 Other baseline variables such as heart rate, respiratory rate, hemoglobin, hematocrit, weight, and functional echocardiographic factors were compared between the 2 groups of neonates between 6 hours pre-blood transfusion and the 24 post-blood transfusion. Over the 30-hour period (6 hours pre-blood transfusion and 24 hours post-blood transfusion), those neonates receiving the placebo had a statistically significantly higher FiO 2 than those neonates who received furosemide (single dose, 1 mL/kg). Weight and serum sodium levels were significantly lower after the blood transfusion in those neonates who received furosemide than in the neonates in the placebo group. No other baseline variables were significant.In the last study, pulmonary function tests (baseline, immediately after blood transfusion, and

Neonatal red blood cell transfusion

“…No difference in clinical respiratory, ventilatory or haemodynamic parameters was reported in another pilot RCT that compared the effect of intravenous furosemide to placebo after elective RBC transfusion in preterm infants [99]. The decision to use furosemide post‐transfusion in preterm infants should consider known adverse effects (electrolyte imbalance, nephrocalcinosis, ototoxicity) and the uncertain benefits [100].…”