Acute Physiological Effects of Packed Red Blood Cell Transfusion in Preterm Infants with Different Degrees of Anemia

Laura K Fredrickson; Edward F Bell; Gretchen A Cress; Karen J Johnson; M. Bridget Zimmerman; Larry T Mahoney; John A Widness; Ronald G Strauss

doi:10.1136/adc.2010.191023

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Acute Physiological Effects of Packed Red Blood Cell Transfusion in Preterm Infants with Different Degrees of Anemia

Journal article

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Acute Physiological Effects of Packed Red Blood Cell Transfusion in Preterm Infants with Different Degrees of Anemia

Laura K Fredrickson, Edward F Bell, Gretchen A Cress, Karen J Johnson, M. Bridget Zimmerman, Larry T Mahoney, John A Widness and Ronald G Strauss

Archives of disease in childhood. Fetal and neonatal edition, Vol.96(4), pp.F249-F253

07/2011

DOI: 10.1136/adc.2010.191023

PMCID: PMC3114194

PMID: 21097838

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https://www.ncbi.nlm.nih.gov/pmc/articles/3114194View

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Abstract

Objective The safe lower limit of haematocrit or haemoglobin that should trigger a red blood cell (RBC) transfusion has not been defined. The objective of this study was to examine the physiological effects of anaemia and compare the acute responses to transfusion in preterm infants who were transfused at higher or lower haematocrit thresholds. Methods The authors studied 41 preterm infants with birth weights 500–1300 g, who were enrolled in a clinical trial comparing high (‘liberal’) and low (‘restrictive’) haematocrit thresholds for transfusion. Measurements were performed before and after a packed RBC transfusion of 15 ml/kg, which was administered because the infant's haematocrit had fallen below the threshold defined by study protocol. Haemoglobin, haematocrit, RBC count, reticulocyte count, lactic acid and erythropoietin were measured before and after transfusion using standard methods. Cardiac output was measured by echocardiography. Oxygen consumption was determined using indirect calorimetry. Systemic oxygen transport and fractional oxygen extraction were calculated. Results Systemic oxygen transport rose in both groups following transfusion. Lactic acid was lower after transfusion in both groups. Oxygen consumption did not change significantly in either group. Cardiac output and fractional oxygen extraction fell after transfusion in the low haematocrit group only. Conclusions These study's results demonstrate no acute physiological benefit of transfusion in the high haematocrit group. The fall in cardiac output with transfusion in the low haematocrit group shows that these infants had increased their cardiac output to maintain adequate tissue oxygen delivery in response to anaemia and, therefore, may have benefitted from transfusion.

Neonatology

Physiology

haematology

clinical procedures

circulatory

Details

Title: Subtitle: Acute Physiological Effects of Packed Red Blood Cell Transfusion in Preterm Infants with Different Degrees of Anemia
Creators: Laura K Fredrickson - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
Edward F Bell - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
Gretchen A Cress - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
Karen J Johnson - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
M. Bridget Zimmerman - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
Larry T Mahoney - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
John A Widness - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
Ronald G Strauss - Department of Pathology, University of Iowa, Iowa City, Iowa, USA
Resource Type: Journal article
Publication Details: Archives of disease in childhood. Fetal and neonatal edition, Vol.96(4), pp.F249-F253
DOI: 10.1136/adc.2010.191023
PMID: 21097838
PMCID: PMC3114194
NLM abbreviation: Arch Dis Child Fetal Neonatal Ed
ISSN: 1359-2998
eISSN: 1468-2052
Language: English
Date published: 07/2011
Academic Unit: Stead Family Department of Pediatrics; Pathology; Biostatistics; Gastroenterology, Hepatology, Pancreatology, and Nutrition; Neonatology
Record Identifier: 9983997480002771

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