The Role of RBC Transfusion in the Premature Infant

Blank, John

doi:10.1001/archpedi.1984.02140470031010

Cited by 57 publications

(50 citation statements)

References 7 publications

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“…24,25 No differences in short-term outcomes were described. Prior recommendations for allogeneic RBC transfusion were derived from small, non-randomized studies, advocating allogeneic RBC transfusions to prevent apnea, to foster weight gain and growth, 26 or to increase oxygenation in ventilated infants.…”

Section: Discussionmentioning

confidence: 99%

The premature infants in need of transfusion (pint) study: A randomized, controlled trial of a restrictive (LOW) versus liberal (HIGH) transfusion threshold for extremely low birth weight infants

Kirpalani¹,

Whyte²,

Andersen

et al. 2006

The Journal of Pediatrics

514

500

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Section: Discussionmentioning

confidence: 99%

The premature infants in need of transfusion (pint) study: A randomized, controlled trial of a restrictive (LOW) versus liberal (HIGH) transfusion threshold for extremely low birth weight infants

Kirpalani¹,

Whyte²,

Andersen

et al. 2006

The Journal of Pediatrics

514

500

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“…Data on the effects of blood transfusions on the frequency of these episodes, however, are conflicting. Some authors have found less apnea and/or bradycardia following transfusion [1][2][3][4][5]; others have not [6][7][8]. Recently, we studied the effects of blood transfusions on the frequency of bradycardia and desaturation, the clinically most important components of AOP [9], in a group of mildly anemic infants and found that there was no effect on AOP [10].…”

Section: Introductionmentioning

confidence: 99%

Blood Transfusion in Anemic Infants with Apnea of Prematurity

Westkamp

Soditt²,

Adrian³

et al. 2002

Neonatology

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We found recently that blood transfusions had no effect on bradycardia and hypoxemia, the clinically important components of apnea of prematurity, in mildly anemic infants. Here, we wanted to know whether this also holds true for more severely anemic patients. Nineteen preterm infants, median gestational age at birth 25 (range 22–30) weeks, age at the time of study 5.5 (range 1–13) weeks, for whom a blood transfusion was ordered because of recurrent episodes of bradycardia and/or hypoxemia in conjunction with anemia (median hemoglobin level 78 g/l, range 63–98 g/l) were investigated. One infant received two transfusions and was thus studied twice. 4-hour recordings of pulse oximeter saturation (SpO₂), pulse waveforms, electrocardiogram, breathing movements, and nasal airflow were performed immediately before transfusion of 20 ml/kg packed red blood cells and again 24 h later. The recordings were analyzed for baseline heart and respiratory rates and SpO₂, all measured during regular breathing, as well as for apnea (≧20 s), bradycardia (heart rate <2/3 of baseline for ≧4 s), and episodic desaturation (SpO₂ ≤80% for ≧4 s). There was no significant change in the combined frequency of bradycardia and desaturation, the primary study end point – median 6.4/h (range 3.0–13.5/h) before versus 4.6/h (range 0.6–15.7/h) after transfusion –, although there was slightly less bradycardia – 0.8/h (range 0.0–8.8/h) versus 0.7/h (range 0.0–5.1/h; p < 0.05). Baseline heart and respiratory rates decreased, respectively, from 163/min (range 140–182/min) and 58/min (range 34–98/min) to 152/min (range 134–172/min) and 55/min (range 36–82/min; p < 0.01). We conclude that blood transfusions significantly reduced heart and respiratory rates in these anemic infants, but had little effect on apnea of prematurity.

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“…It has been suggested that the RCV is a better guide to red cell transfusion requirements than Hb concentration (l-3), which has been shown to be a poor predictor of benefit from blood transfusion (4)(5)(6). After acute blood loss and in anemia of prematurity, the Hb concentration is poorly correlated with RCV; some infants have a very low RCV, yet maintain an adequate Hb concentration (1,2,7).…”

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confidence: 99%

Biotin Labeling of Red Cells in the Measurement of Red Cell Volume in Preterm Infants

et al. 1990

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ABSTRACT. Determination of circulating red cell volume (RCV) in anemic preterm infants is, in theory, a better indicator of transfusion needs than Hb concentration. Our study reports the results of RCV measurement using biotin labeling of red cells on 40 occasions in preterm infants of 25-34 wk gestation. In 20 infants, who had estimations made within 24 h of birth, the RCV varied between 17.7 and 66 mL/kg. Twenty measurements were made at a later age at the time of a blood transfusion. RCV values were between 13.1 and 41.5 mL/kg before transfusion. In 13 infants, RCV was determined simultaneously using two methods, biotin and dilution of autologous HbF with donor HbA at transfusion. There was no significant difference between the results of RCV estimations using these two methods. Our study demonstrates that biotin labeling is an effective method for determining RCV in preterm infants. The RCV represents the total volume of red cells in the circulation. It has been suggested that the RCV is a better guide to red cell transfusion requirements than Hb concentration (l-3), which has been shown to be a poor predictor of benefit from blood transfusion (4-6). After acute blood loss and in anemia of prematurity, the Hb concentration is poorly correlated with RCV; some infants have a very low RCV, yet maintain an adequate Hb concentration (1, 2, 7). RCV may also be a more rational physiologic indicator than Hb concentration of the oxygen carrying capacity of the blood in the whole circulation (3). Low RCV at birth is associated with birth asphyxia (8, 9), increasing severity of hyaline membrane disease (9, lo), and increased mortality (8, 10). RCV estimation has become a vital investigation in adults with polycythemias, some anemias, and the assessment of erythropoiesis (1 1).Previously described methods for determining RCV include both techniques using the dilution principle after labeling of red cells with a tracer and indirect methods, which give a calculated RCV derived from plasma volume and Hct. Radioisotopes as tracers (1 1 iably to overestimate plasma volume. Accurate calculation of RCV from plasma volume requires not only accurate plasma volume estimation but also a knowledge of the total body Hct. Although correction factors allow for the difference between venous and total body Hct (14, 15, 16), they are of quite unknown reliability in sick infants. RCV can be estimated using dilution of autologous HbF at the time of a blood transfusion (2, 17). This is reliable provided that HbF estimation is accurate (e.g. alkali denaturation technique) (2) and at least 20% of the Hb in the circulation before transfusion is fetal. This technique cannot be used without a donor blood transfusion.A new method has recently been described for determination of RCV in adults. Biotin is used to label autologous red cells, and their dilution is quantitated in a fluorescence-activated cell sorter using the fluorescein-streptavidin reaction (17). Biotin is not toxic in infants, even in pharmacologic doses (1 8).We report here results...

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The Role of RBC Transfusion in the Premature Infant

Cited by 57 publications

References 7 publications

The premature infants in need of transfusion (pint) study: A randomized, controlled trial of a restrictive (LOW) versus liberal (HIGH) transfusion threshold for extremely low birth weight infants

The premature infants in need of transfusion (pint) study: A randomized, controlled trial of a restrictive (LOW) versus liberal (HIGH) transfusion threshold for extremely low birth weight infants

Blood Transfusion in Anemic Infants with Apnea of Prematurity

Biotin Labeling of Red Cells in the Measurement of Red Cell Volume in Preterm Infants

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