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

Abstract

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.

Survey on Pattern and Determinants of Blood Transfusion in Benha Neonatal Intensive Unit

“…While 68.6% of cases didn't have complication after blood transfusion. Parallel to our findings, Abdelghaffar et al (18) , reported that serum electrolytes were affected by blood transfusions, and compared to those who didn't receive blood transfusion there was a considerable increase of serum K + (4.48 ± 1.19 mmol/l vs 5.83 ± 1.37 mmol/l; P<0.001), and a considerable decrease of Ca +2 (1.33 ± 0.09 mmol/l vs 1.30 ± 0.09 mmol/l; P<0.001). Six (15%) of infants developed hyperkalemia following the RBC transfusion.…”

Comparison of Mean Platelet Counts in Preterm Infants with and without Retinopathy of Prematurity

“…Preterm infants often have immature hematopoietic systems with inefficient erythropoiesis. The frequent phlebotomies required in these infants place them at greater risk of requiring blood transfusions [ 32 ]. Red blood cell transfusion has been shown to be an independent risk factor for the development of ROP, and this risk is proportionate to the volume transfused [ 25 ].…”