Multiple red blood cell transfusions and iron overload in very low birthweight infants

Treviño-Báez, Joaquín Darío; Briones-Lara, Evangelina; Alamillo-Velázquez, J.; Martínez-Moreno, M. I.

doi:10.1111/vox.12528

Cited by 12 publications

(6 citation statements)

References 22 publications

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“…In a previous study conducted by Chai et al, the colony‐forming cell assays demonstrated that iron overload resulted in the decline of hematopoietic colony‐forming count and damaged the colony formation and the hematopoietic reconstitution in HSCs 19 . Several RBC transfusions could bring iron overload since there are no available physiological pathways eliminating excess iron stored in the reticuloendothelial and endocrine systems as well as in the liver and heart 20 . Another study demonstrated that decreased RBC counts were associated with reduced complications related to transfusion as secondary iron overload 21 .…”

Section: Discussionmentioning

confidence: 99%

“…18 Subsequently, observations revealed that colony formation, peripheral RBC counts and HGB concentration were reduced, while platelet counts were increased in response to iron overload after allo-HSCT. In a previous study conducted by Chai 20 Another study demonstrated that decreased RBC counts were associated with reduced complications related to transfusion as secondary iron overload. 21 The essential effects of decreased HGB level on the assessment of iron overload patients were also previously reported.…”

Section: Allo-hsct In An Iron-overloaded Mice Negatively Impacts Sumentioning

confidence: 94%

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Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Lin

Chen

et al. 2020

The Kaohsiung J of Med Scie

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Hematological malignancies are increasingly treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, iron overload is a frequent adverse effect of allo-HSCT and is associated with poor prognosis. In the present study, we investigated hematopoiesis in iron-overloaded mice and elucidated the effects of iron overload on the bone marrow (BM) microenvironment. Ironoverloaded BALB/C mice were generated by injecting 20 mg/mL saccharated iron oxide intraperitoneally. Hematoxylin-eosin staining was performed to evaluate the effects of an iron overload in mice. BM cells obtained from C57BL/6 mice were transplanted into irradiated BALB/C mice (whole-body irradiation of 4 Gy, twice with a 4-hours interval) by tail vein injection. Two weeks after allo-HSCT, the hematopoietic reconstitution capacity was evaluated in recipients by colony-forming assays. Histopathological examinations showed brown-stained granular deposits, irregularly arranged lymphocytes in the liver tissues, and blue-stained blocks in the BM collected from mice received injections of high-dose saccharated iron oxide (20 mg/mL). Ironoverloaded mice showed more platelets, higher-hemoglobin (HGB) concentration, fewer granulocyte-macrophage colony-forming units (CFU-GM), erythrocyte colonyforming units (CFU-E), and mixed granulocyte/erythrocyte/monocyte/megakaryocyte colony-forming units (CFU-mix) than healthy mice. Iron-overloaded recipients presented with reduced erythrocytes and HGB concentration in peripheral blood, along with decreased marrow stroma cells, CFU-GM, CFU-E, and CFU-mix relative to healthy recipients. Taken together, our findings demonstrate that iron overload might alter the number of red blood cells after transplantation in mice by destroying the

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Section: Discussionmentioning

confidence: 99%

Section: Allo-hsct In An Iron-overloaded Mice Negatively Impacts Sumentioning

confidence: 94%

Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Lin

Chen

et al. 2020

The Kaohsiung J of Med Scie

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“…Recent postmortem studies showed that premature neonates who receive multiple blood transfusions often exhibit iron excess (Park and Kim, 2015; Trevino-Baez et al., 2017). Free iron might be released from senescent red blood cells by transfusion hemolysis, and low circulating levels of transferrin and other iron-binding proteins in premature neonates might increase circulation of non-protein-bound iron.…”

Section: Impact Of Iron Imbalance On Brain Development In Preterm Infmentioning

confidence: 99%

“…Premature neonates that receive more erythrocyte transfusions not only could replace phlebotomy losses but also maintain certain level of Hb concentrations. Physicians use erythrocyte transfusions as a frequent intervention when treating preterm infants with very low birth weight (birth weight <1,500 g) (Trevino-Baez et al., 2017). This poses several risks, including iron overload (Park and Kim, 2015), because excess iron is not able to be eliminated by physiological pathways, even though the iron released after degradation of the transfused red blood cells increases body iron storage.…”

Section: Risk Factors For Iron Imbalance In Preterm Infantsmentioning

confidence: 99%

Iron Metabolism and Brain Development in Premature Infants

Wang

et al. 2019

Front. Physiol.

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Iron is important for a remarkable array of essential functions during brain development, and it needs to be provided in adequate amounts, especially to preterm infants. In this review article, we provide an overview of iron metabolism and homeostasis at the cellular level, as well as its regulation at the mRNA translation level, and we emphasize the importance of iron for brain development in fetal and early life in preterm infants. We also review the risk factors for disrupted iron metabolism that lead to high risk of developing iron deficiency and subsequent adverse effects on neurodevelopment in preterm infants. At the other extreme, iron overload, which is usually caused by excess iron supplementation in iron-replete preterm infants, might negatively impact brain development or even induce brain injury. Maintaining the balance of iron during the fetal and neonatal periods is important, and thus iron status should be monitored routinely and evaluated thoroughly during the neonatal period or before discharge of preterm infants so that iron supplementation can be individualized.

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“…Red blood cell transfusion can increase hemoglobin serum levels and ferritin levels in preterm infants (32). Some researchers claimed that multiple RBC transfusions might tip the balance of iron homeostasis in premature infants and then lead to a higher risk of iron overload, and recommended caution in giving iron supplements in this patient population (33,34). In our study, 4% infant had a history of multiple blood transfusions.…”

Section: Discussionmentioning

confidence: 54%

Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants

Ying

et al. 2021

Front. Pediatr.

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Objective: The aim of this study was to investigate the effects of unified iron supplementation and identify the factors related to the iron homeostasis among preterm infants.Method: A total of 250 preterm infants were divided into neonatal anemic (NA, n = 154) and non-neonatal anemic group (NNA, n = 96). Iron supplements at a dose of 2 mg/kg per day were given from 40 weeks' gestational age to 6 months. Iron status parameters were measured at 3 and 6 months, respectively. Prevalence of iron deficiency (ID) and iron deficiency anemia (IDA), and the correlated factors were analyzed. Growth and side-effects were monitored.Results: There were no significant differences for the prevalence of ID or IDA between the two groups. Multivariate regression analyses showed that higher Hb at birth and early treatment of blood transfusion reduced the risk of ID/IDA at 3 months (all p < 0.05); while higher level of Hb at 3 months (p = 0.004) and formula feeding reduced the occurrence of ID/IDA at 6 months (p < 0.05); males had a 3.35 times higher risk to develop ID/IDA than girls (p = 0.021). No differences in growth and side effects were found.Conclusion: A daily dose of 2 mg/kg iron supplement is beneficial to maintain iron homeostasis in majority preterm infants within 6 months regardless of their neonatal anemia history. Under the routine iron supplementation, Hb level at birth and at 3 months, early treatment of blood transfusion, gender and feeding patterns are the major factors affecting the prevalence of ID/IDA among preterm infants in infancy.

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Multiple red blood cell transfusions and iron overload in very low birthweight infants

Abstract: There was a higher risk of iron overload in exposed infants in comparison with non-exposed infants. Severe iron overload in VLBW infants may occur with a total transfusion volume >120 ml/kg.

Cited by 12 publications

References 22 publications

Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation

Iron Metabolism and Brain Development in Premature Infants

Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants

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