Blood products transfusion and retinopathy of prematurity: A cohort study

Abstract

Aim:The aim of the study was to assess the influence of blood product transfusions on the development and severity of retinopathy of prematurity (ROP).Methods: A retrospective cohort study was conducted of very low birth weight (VLBW) newborns with less than 32 weeks gestational age (GA) admitted to the neonatal unit of a tertiary care hospital during the period from 1 January 2008 to 31 December 2021. Data on the degree of ROP and the transfusions received were obtained and analysed. Both univariate and multivariate analyses were performed, by logistic regression.Results: A total of 565 VLBW newborns were recruited, of whom 263 received a red blood cell transfusion prior to 36 weeks corrected GA. The newborns with ROP received significantly more red blood cell transfusions than those not presenting this condition. After adjusting for oxygen therapy and GA, the risk of ROP was found to be 2.77 times higher (95% CI 1.31-5.88) after receiving three or more transfusions, with a 3.95 times higher risk (95% CI 1.40-11.1) of developing severe ROP.Having received the first red blood cell transfusion before 32 weeks corrected GA is associated with an increased risk of ROP (OR 2.18; 95% CI: 1.09-4.36). Conclusion:In VLBW neonates, the number of red blood cell transfusions and their administration before 32 weeks corrected GA are important risk factors for ROP.

Erythrocyte transfusions are associated with retinopathy of prematurity in extremely low gestational age newborns

“…The latter increased the odds by 1.4‐, 2.1‐ and 3.6‐fold. Our findings are in line with two previous nationwide studies, 3,9 a number of retrospective single‐centre studies and few prospective trials, including the TR‐ROP trial 8,10–12 . However, to the best of our knowledge, the present study is the first network study comprising a cohort of ELGANs of that size confirming an association of RBC transfusions with ROP development.…”

“…Several previous studies including the TR-ROP trial found an association between the numbers of RBC units transfused and risk increases for ROP and ROP severity respectively. 3,[10][11][12]19 Moreover, there is evidence that the time of RBC administration may impact transfusion-related risk increases. Previous studies reported that RBC transfusions in the first 10 days, or the first month of life, or before 32 weeks of gestation were significantly associated with increased risk of ROP and severe ROP.…”

Systemic Cytokines in Retinopathy of Prematurity

“…As Hb delivers oxygen throughout the whole body, a decreased concentration of circulating hemoglobin represents the general hypoxia status and potentially increases VEGF secretion [ 301 ]. Several studies have also pointed out the association between ROP development and transfusion of RBCs, especially in the early postnatal period, when phase 1 of ROP occurs [ 302 , 303 , 304 ]. The risk of ROP is even higher as the frequency and volume of transfusions increase [ 305 ].…”

“…The risk of ROP is even higher as the frequency and volume of transfusions increase [ 305 ]. The proposed hypothesis of etiology included (1) transfusion of adult RBCs, which is mainly composed of HbA that releases more oxygen than HbF, the primary type of Hb in infants, to the retinal tissue and causes hyperoxia-induced damage [ 302 , 305 ]; (2) accumulation of free iron leading to oxidative stress [ 302 , 306 ]; and (3) alteration in cytokine profiles after blood transfusion [ 307 , 308 , 309 ]. In patients receiving a massive RBC transfusion, higher blood IL-1β, IL-6, IL-8, IL-17A, and TNF-α levels were detected later in life [ 307 , 308 , 309 ].…”

“…The correlation between thrombocytopenia and severe ROP has been hypothesized and proven in several studies [ 85 ], especially during the first week of life [ 313 , 314 ]. Contrary to the theoretical protective effect of platelets, transfusion of platelets was reported to be an aggravating factor for ROP development due to the contained pro-inflammatory cytokines and their interactions with immune cells [ 302 , 305 , 315 ].…”