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Red Blood Cell Transfusion Thresholds for Anemia of Prematurity
Journal article   Open access   Peer reviewed

Red Blood Cell Transfusion Thresholds for Anemia of Prematurity

Lindsay F Holzapfel, Matthew A Rysavy and Edward F Bell
Neoreviews (Elk Grove Village, Ill.), Vol.24(6), pp.e370-e376
06/01/2023
DOI: 10.1542/neo.24-6-e370
PMCID: PMC10865726
PMID: 37258497
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC10865726/pdf/nihms-1963167.pdfView
Open Access

Abstract

Anemia of prematurity affects the majority of preterm infants, particularly extremely low birthweight infants. Anemia of prematurity arises from both innate and iatrogenic causes and results in more than 80% of extremely preterm infants receiving red blood cell transfusions during the first month after birth. Multiple randomized controlled trials were conducted to evaluate the effect of using lower versus higher transfusion thresholds based on hemoglobin levels. These trials showed no difference in the primary outcome of neurodevelopmental impairment at 2 years of age between lower and higher thresholds. However, some uncertainties about transfusion thresholds remain. This review elaborates the following: 1) the etiology, prevention, and treatment of anemia of prematurity with a focus on red blood cell transfusions, 2) the history of randomized controlled trials on the treatment of anemia of prematurity, and 3) limitations of the evidence and remaining questions about thresholds for red blood cell transfusions in preterm infants.

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