Paediatric transfusion

Copper, zinc and iron levels in premature infants following red blood cell transfusion

This study aimed to investigate effect of erythrocyte suspension (ES) transfusion on Cu, Zn, and Fe levels. It was conducted on 53 premature infants who were admitted to Hacettepe Hospital and received EST for first time. Blood samples were drawn before and 96h after ES transfusion to determine Cu, Zn, and Fe levels in plasma and/or erythrocytes. The mean plasma Cu levels were 99±3μg/dl and 113±3μg/dl; Zn levels were 105±2μg/dl and 115±23μg/dl; mean plasma Fe level was 58.1±19.4 and 75.2±25.4μg/dl and mean erythrocyte Fe level was 4182±2314μg/ml and 7009±5228μg/ml, before and after ES transfusion. The differences between before and after ES transfusion in Cu, Zn and Fe levels were significant. Correlation between plasma and erythrocyte Fe levels was significant both before and after ES transfusion. Though Fe overload is a major cause of morbidity/mortality after ES transfusion, alterations in trace elements should also be considered when transfusing blood to infants and children.

Strict red blood cell transfusion guideline reduces the need for transfusions in very-low-birthweight infants in the first 4 weeks of life: a multicentre trial

BACKGROUND AND OBJECTIVES

Very-low-birthweight infants are among the most heavily transfused patients. The objective of this study was to verify if the introduction of a strict guideline would reduce the need for red blood cell transfusions in the first 4 weeks of life in these neonates.

MATERIALS AND METHODS

This was a multicentre prospective study of two cohorts of very-low-birthweight infants transfused in accordance with the recommendations of a neonatologist (Phase 1) or according to previously published guidelines (Phase 2).

RESULTS

In the first 28 days of life, 102 patients (68.5%) in Phase 1 and 117 (59.7%) in Phase 2 were transfused. The number of transfusions was 1.9 +/- 2.0 in Phase 1 and 1.4 +/- 1.6 in Phase 2 (P = 0.01). After adjusting for gestational age, blood loss and the presence of respiratory distress syndrome, the strict guideline reduced the number of transfusions in 17.6% (IC 95%-30.5% to -2.6%).

CONCLUSIONS

The strict guideline was effective in reducing erythrocyte transfusions in very-low-birthweight infants.

Issues in transfusing preterm infants in the NICU

Decisions regarding whether or not to transfuse preterm infants in the neonatal intensive care unit are often difficult. Although numbers of red blood cell transfusions have decreased in recent years, transfusions are still a common occurrence. For each infant, the advantages of transfusion must be balanced against the consequences and potential risks. This article examines physiologic and iatrogenic causes of anemia in preterm infants, clinical consequences of anemia, the use of transfusions and their risks, and the role of erythropoietin therapy.

Blood transfusion in newborn

Premature infants are among the most frequently transfused groups of patients, usually receiving red cells. The immaturity of the immune system, its lesser ability to cope with a metabolic load and the presence of maternal antibodies, all complicate the picture. Conservation of blood to minimize losses and the need for replacement transfusion is an important strategy that has already been successful in reducing the need for transfusion on neonatal units. The advent of erythropoietin provides another strategy for reducing the need for transfusion. It is unfortunate that the sickest patients who require the most transfusion poorly respond to erythropoietin. Main concern is the long-term consequences of transfusion. Presently the aim is to minimize transfusion risks and give transfusions only when they are indicated.