Use of Erythropoietin and Its Effects on Blood Lactate and 2,3-Diphosphoglycerate in Premature Neonates

Soubasi, Vasiliki; Kremenopoulos, George; Tsantali, Chaido; Savopoulou, Persefoni; Mussafiris, Constantine; Dimitriou, Maria

doi:10.1159/000014280

Cited by 22 publications

(5 citation statements)

References 17 publications

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“…We estimated that concentrations of the solutes might well reach dangerous or toxic levels in the setting of massive transfusion while the quantity of additives in small volume transfusions would be unlikely to result in cumulative toxicity over time and could be further reduced with hard packing to a haematocrit of 80%. Our theoretical calculations have been supported by at least six infant studies [12–19] (Table 2). While each study is slightly different in the age of the product used, volume per kg transfused, type of anticoagulant, clinical and laboratory parameters measured, none demonstrated adverse metabolic consequences like hyperglycaemia, hypoglycaemia, hypocalcaemia, hyperkalaemia, and hypernatraemia.…”

Section: Red Blood Cells For Small Volume Transfusionsupporting

confidence: 69%

Neonatal red blood cell transfusions

Luban

2004

Vox Sanguinis

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Red blood cell and blood product transfusions in the fetus, neonate and premature infant are often administered with poorly defined indications and unintentional adverse consequences. Products may be altered in an effort to limit potential adverse events or be specially selected to meet the unique needs of a specific diagnosis. One area of particular concern to neonatologists is selecting blood for small volume (5-20 ml/kg) transfusions in prematures.For infants, red blood cells (RBC's) collected in anticoagulantadditive solutions and administered in small aliquots over the shelf life of the product to decrease donor exposure has supplanted the use of fresh RBC's where each transfusion resulted in a donor exposure. The safety of this practice has been documented and procedures established to aid a transfusion service in making these products available. Less well established are the indications for transfusion in this population; haemoglobin or haematocrit alone are likely insufficient unless clinical findings like oxygen desaturation, apnea and bradycardia are part of the criteria used to define transfusion need. The comorbidities that increase oxygen demands in these infants, like bronchopulmonary dysplasia and increased oxygen consumption to accommodate growth, must be part of the decision to transfuse. Non-invasive methods or assays that will reflect the unique pathophysiology of oxygen delivery and peripheral oxygen offloading are needed. Red blood cells for small volume transfusionMost newborns of 24 -27 weeks' gestation will require transfusions of RBC's [1]. Restrictive guidelines have been developed which have decreased donor exposure and transfusion number, but several factors continue to contribute to the need to transfuse. These include iatrogenic anaemia, oxidative haemolysis often from sepsis, and rapid growth with concomitant protein and iron deficiency. The selection of the transfusion product continues to be controversial. Specific issues include (1) age of the blood and hence the quantity of intraerythrocyte, 2,3DPG and oxygen offloading capacity;(2) potassium content which increases over storage time;(3) solute load from the anticoagulant solutions which might result in osmotic diuresis with subsequent alteration of cerebral microcirculation with resultant periventricular haemorrhage; (4) transfusion-associated viral diseases and graft-vs.-hostdisease resulting from passive transfer of viral-infected monocytes and engraftable lymphocytes, respectively.Several clinical articles and one review have addressed the transfusion of RBC's packaged in small volumes in different anticoagulant-solutions to reduce donor exposure [2][3][4][5][6][7][8]. The solutions have in common the use of mannitol, glucose, sodium chloride, phosphate and other additives (Table 1). To ensure that the haematocrit is more comparable to a standard packed RBC's, and to decrease the volume of blood in very low birth weight infants where volume overload is common, they can be concentrated by either centrifugation [9] or inverted...

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Section: Red Blood Cells For Small Volume Transfusionsupporting

confidence: 69%

Neonatal red blood cell transfusions

Luban

2004

Vox Sanguinis

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“…37 The latter result could be related to the increase in 2,3-diphosphoglycerate levels in RBCs causing a right shift in the oxygen dissociation curve. 38 Anaemia associated with malignancy Anaemia is a complication commonly encountered in malignancy, especially of haematological origin, either at presentation or during the course of treatment. Anaemia of chronic disease, a condition characterised by disordered iron metabolism, shortened RBC half life and inefficient erythropoiesis, is the major contributor to cancer anaemia.…”

Section: Anaemia Associated With Chronic Renal Diseasementioning

confidence: 99%

Recombinant erythropoietin in clinical practice

Marx

Littlewood

et al. 2003

Postgraduate Medical Journal

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The introduction of recombinant human erythropoietin (RHuEPO) has revolutionised the treatment of patients with anaemia of chronic renal disease. Clinical studies have demonstrated that RHuEPO is also useful in various non-uraemic conditions including haematological and oncological disorders, prematurity, HIV infection, and perioperative therapies. Besides highlighting both the historical and functional aspects of RHuEPO, this review discusses the applications of RHuEPO in clinical practice and the potential problems of RHuEPO treatment.

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“…At the same time, it has been reported in assessments of lactate levels using arterial blood that lactate level significantly decreases when RBC are transfused 10–14 . We measured lactate level using the venous blood because frequent arterial punctures are very invasive for newborn infants, but the lactate level decreased after the transfusion in patients with a lactate level 3.3 mmol/L before transfusion, thus indicating the possibility of tissue hypoxia.…”

Section: Discussionmentioning

confidence: 94%