Blood Transfusions Improved for Preterm Infants

Transfusion of packed red blood cells (PRBCs) saves lives in the neonatal critical care setting and is one of the most common interventions in the preterm infant.

The number and volume of PRBC transfusions are associated with several major neonatal morbidities, although a direct causal link between transfusion and major neonatal morbidity has yet to be proven.

Scientists at the Robinson Institute, the University of Adelaide, (Australia) studied 28 preterm babies at 28 weeks' gestation or less, who were given packed red blood cell transfusions. Plasma inflammatory cytokines and markers of endothelial activation were measured in the infants before and two to four hours after transfusion, as well as in the donor pack. The median age range at transfusion was 18 days with the pretransfusion hemoglobin level at 9.8 g/dL, with a range of 7.4–10.2 g/dL.

The interleukin (IL)-1β, IL-8, tumor necrosis factor-α, and the monocyte chemoattractant protein were increased after transfusion. A similar elevation in markers of endothelial activation was seen after transfusion with increased plasma macrophage inhibitory factor and soluble intracellular adhesion molecule. Cytokines were analyzed by Milliplex MAP Human Cytokine/Chemokine enzyme-linked immunosorbent assays (ELISA) (Merck Millipore; Billerica, MA, USA).

Michael J. Stark, PhD, the lead author of the study said, "Within two to four hours of preterm babies receiving a blood transfusion, we have seen elevated levels of cytokines and chemokines, signaling cells that stimulate inflammatory responses in the body. We believe that the bioactive components of packed red blood cell transfusions are initiating or amplifying these inflammatory processes in the body. "The authors concluded that production of inflammatory cytokines and immunoactivation of the endothelium observed after the transfusion of PRBCs in the preterm infant may be a manifestation of transfusion-related immunomodulation (TRIM). The study was published on November 21, 2012, in the journal Pediatric Research.

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