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Factors affecting efficacy of packed red blood cell transfusion in neonates

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Abstract

The degree of increase in haematocrit and equilibration time following packed red blood cell (PRBC) transfusion in neonates is not well studied. We evaluated change in haematocrit 15 min, 6 h and 24 h after PRBC transfusion in neonates and factors predicting this change. Among neonates receiving PRBC transfusion, we recorded pre-transfusion haematocrit and a priori identified putative variables affecting change in haematocrit following transfusion. The factors affecting change in haematocrit were analyzed by multiple linear regression analysis. Eighty-one neonates received 119 PRBC transfusions (mean volume 16 ± 4 mL/kg). Haematocrit increased from 26 ± 5 to 41 ± 5% at 15 min after PRBC transfusion (p = 0.001) and remained stable till 6 h (41 ± 5%, p = 0.11). It decreased to 40 ± 5%, at 24 h post transfusion (p < 0.001). On linear regression analysis, baseline haematocrit of the baby, donor blood haematocrit and volume of PRBC transfusion were independent determinants of increase in haematocrit.

Conclusion: After 16 mL/kg PRBC transfusion in neonates, haematocrit increased by 15% at 15 min post transfusion. The equilibration in haematocrit values was achieved by 15 min after transfusion. Baseline haematocrit of neonate, donor blood haematocrit and transfusion volume independently determine the rise in haematocrit.

What is Known:

• Rise in haematocrit following PRBC transfusion in neonates has been studied in a small number of stable infants.

• Determinants of efficacy of PRBC transfusion have not been well studied in newborns.

What is New:

• Each milliliter/kilogramme of PRBC transfusion increases the neonate’s haematocrit by approximately 1%.

• Baseline haematocrit, donor blood haematocrit and transfusion volume per kilogramme body weight independently determine the rise in haematocrit.

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Abbreviations

CI:

Confidence interval

FST:

Fluorescent spot test

G6PD:

Glucose-6-phosphate dehydrogenase

IQR:

Interquartile range

PRBC:

Packed red blood cell

SD:

Standard deviation

SNAP-II:

Score for Neonatal Acute Physiology II

STB:

Serum total bilirubin

References

  1. Gibson BE, Todd A, Roberts I, Pamphilon D, Rodeck C, Bolton-Maggs P, Burbin G, Duguid J, Boulton F, Cohen H, Smith N, McClelland DB, Rowley M, Turner G, British Committee for Standards in Haematology Transfusion Task Force: writing group (2004) Transfusion guidelines for neonates and older children. Br J Haematol 124(4):433–453

    Article  PubMed  Google Scholar 

  2. Bifano EM, Curran TR (1995) Minimizing donor blood exposure in the neonatal intensive care unit. Current trends and future prospects. Clin Perinatol 22(3):657–669

    CAS  PubMed  Google Scholar 

  3. Guillen U, Cummings JJ, Bell EF, Hosono S, Frantz AR, Maier RF, Whyte RK, Boyle E, Vento M, Widness JA, Kirpalani H (2012) International survey of transfusion practices for extremely premature infants. Semin Perinatol 36(4):244–247. doi:10.1053/j.semperi.2012.04.004

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sekhsaria S, Fomufod A (1991) Readjustment of hematocrit values after packed red cell transfusion in the neonate. J Perinatol 11(2):161–163

    CAS  PubMed  Google Scholar 

  5. Paul DA, Leef KH, Locke RG, Stefano JL (2002) Transfusion volume in infants with very low birth weight: a randomized trial of 10 versus 20 ml/kg. J Pediatr Hematol Oncol 24(1):43–46

    Article  PubMed  Google Scholar 

  6. Glatstein M, Oron T, Barak M, Mimouni FB, Dollberg S (2005) Posttransfusion equilibration of hematocrit in hemodynamically stable neonates. Pediatr Crit Care Med 6(6):707–708

    Article  PubMed  Google Scholar 

  7. Kelly AM, Williamson LM (2013) Neonatal transfusion. Early Hum Dev 89(11):855–860. doi:10.1016/j.earlhumdev.2013.08.025

    Article  PubMed  Google Scholar 

  8. Davies P, Robertson S, Hegde S, Greenwood R, Massey E, Davis P (2007) Calculating the required transfusion volume in children. Transfusion 47(2):212–216. doi:10.1111/j.1537-2995.2007.01091.x

    Article  PubMed  Google Scholar 

  9. Audu LI, Otuneye AT, Mairami AB, Mshelia LJ, Nwatah VE (2015) Posttransfusion haematocrit equilibration: timing posttransfusion haematocrit check in neonates at the national hospital, Abuja, Nigeria. Int J Pediatr 2015:175867

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Shannon KM, Keith JF 3rd, Mentzer WC, Ehrenkranz RA, Brown MS, Widness JA, Gleason CA, Bifano EM, Millard DD, Davis CB et al (1995) Recombinant human erythropoietin stimulates erythropoiesis and reduces erythrocyte transfusions in very low birth weight preterm infants. Pediatrics 95(1):1–8

    CAS  PubMed  Google Scholar 

  11. Dutta S, Kumar P (2010) Anemia. In: Dutta S, Kumar P (eds) The blue book. PGI NICU handbook of protocols, 4th edn. Chandika press Pvt Ltd, Ind Estate, Barwala (Haryana) India, pp. 163–170

    Google Scholar 

  12. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R (1991) New Ballard Score, expanded to include extremely premature infants. J Pediatr 119(3):417–423

    Article  CAS  PubMed  Google Scholar 

  13. World Health Organization: Recommended method for the determination of packed cell volume by centrifugation (prepared by Expert Panel on Cytometry of the International Council for Standardization in Haematology) document WHO/DIL/00.2, Geneva: WHO; 2000:1-9

  14. Richardson DK, Corcoran JD, Escobar GJ, Lee SK (2001) SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 138(1):92–100

    Article  CAS  PubMed  Google Scholar 

  15. Beutler E, Blume KG, Kaplan JC, Lohr GW, Ramot B, Valentine WN (1979) International Committee for Standardization in Haematology: recommended screening test for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Br J Haematol 43(3):465–467

    Article  CAS  PubMed  Google Scholar 

  16. Kaeda JS, Chhotray GP, Ranjit MR, Bautista JM, Reddy PH, Stevens D, Naidu JM, Britt RP, Vulliamy TJ, Luzzatto L et al (1995) A new glucose-6-phosphate dehydrogenase variant, G6PD Orissa (44 Ala-->Gly), is the major polymorphic variant in tribal populations in India. Am J Hum Genet 57(6):1335–1341

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Standefer JC, Vanderjagt D (1977) Use of tetramethylbenzidine in plasma hemoglobin assay. Clin Chem 23(4):749–751

    CAS  PubMed  Google Scholar 

  18. Saran R K, India. Directorate General of Health Services, World Health Organization (2003) Quality assurance in blood transfusion. Transfusion medicine: technical manual, 2nd edn. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, pp. 352

  19. Adedoyin OT, Afolabi JK, Oyeyemi B (2004) Proposed formulae for determining blood transfusion requirements in children with severe anaemia. Nigerian Journal of Paediatrics 31(1):25–28

    Google Scholar 

  20. Naidech AM, Kahn MJ, Soong W, Green D, Batjer HH, Bleck TP (2008) Packed red blood cell transfusion causes greater hemoglobin rise at a lower starting hemoglobin in patients with subarachnoid hemorrhage. Neurocrit Care 9(2):198–203

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Rakesh Kumar Pilania, Shiv Sajan Saini, Sourabh Dutta & Praveen Kumar

  2. Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Reena Das

  3. Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Neelam Marwaha

Authors
  1. Rakesh Kumar Pilania
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  2. Shiv Sajan Saini
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  3. Sourabh Dutta
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  4. Reena Das
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  5. Neelam Marwaha
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  6. Praveen Kumar
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Corresponding author

Correspondence to Praveen Kumar.

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No funds were granted for this study.

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The authors declare that they have no competing interests.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Prior to the conduct of the study, approval was taken from the institutional ethical review board.

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Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Patrick Van Reempts

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Pilania, R.K., Saini, S.S., Dutta, S. et al. Factors affecting efficacy of packed red blood cell transfusion in neonates. Eur J Pediatr 176, 67–74 (2017). https://doi.org/10.1007/s00431-016-2806-7

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  • DOI: https://doi.org/10.1007/s00431-016-2806-7

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