In premature infants there is no decrease in 24‐hour posttransfusion allogeneic red blood cell recovery after 42 days of storage

Abstract

Background Critically ill preterm very low birth weight (VLBW) neonates (birthweight ≤1.5 kg) frequently develop anemia that is treated with red blood cell (RBC) transfusions. Although RBC transfused to adults demonstrate progressive decreases in post-transfusion 24-hour RBC recovery (PTR24) during storage—to a mean of about 85% of the FDA allowed 42-day storage—limited data in infants indicate no decrease in PTR24 with storage. Study Design and Methods We hypothesized that PTR24 of allogeneic RBCs transfused to anemic VLBW newborns: 1) will be greater than PTR24 of autologous RBCs transfused into healthy adults; and 2) will not decrease with increasing storage duration. RBCs were stored at 4°C for ≤42 days in AS-3 or AS-5. PTR24 was determined in 46 VLBW neonates using biotin-labeled RBC and in 76 healthy adults using 51Cr-labeled RBC. Linear mixed model analysis was used to estimate slopes and intercepts of PTR24 versus duration of RBC storage. Results For VLBW newborns, the estimated slope of PTR24 versus storage did not decrease with the duration of storage (P=0.18) while for adults it did (P<0.0001). These estimated slopes differed significantly in adults compared to newborns (P=0.04). At the allowed 42 d storage limit, projected mean neonatal PTR24 was 95.9%; for adults, it was 83.8% (P=0.0002). Conclusions These data provide evidence that storage duration of allogeneic RBCs intended for neonates can be increased without affecting PTR24. This conclusion supports the practice of transfusing RBCs stored up to 42 days for small-volume neonatal transfusions to limit donor exposure.

Hypoxic storage of red blood cells improves metabolism and post‐transfusion recovery

“…In addition, PTR in healthy subjects does not suffice to provide information on the actual RBC recovery in nonhealthy, heterologous patients. Several studies have highlighted that PTR of allogenically transfused RBC in patients with acute inflammatory disorders is significantly reduced, while in patients with immature innate immune systems, the PTR is increased or is insensitive to age‐mediated storage …”

Development, validation, and potential applications of biotinylated red blood cells for posttransfusion kinetics and other physiological studies: evidenced‐based analysis and recommendations

“…Multiple determinations of PTR 24 can be made based on the ratio of BioRBC‐N enrichment at 24 hours relative to that immediately following the BioRBC transfusion. In all studies using fresh autologous or stored donor RBCs in naïve subjects, PTR 24 values for the BioRBC‐N have consistently agreed within analytical error, providing evidence that there is negligible early cell loss of BioRBC‐N . The FDA relies exclusively on 51 Cr‐labeled RBCs for determination of PTR 24 for regulatory review of safety and efficacy (e.g., licensing of RBC storage media) .…”

Association of donor age, body mass index, hemoglobin, and smoking status with in‐hospital mortality and length of stay among red blood cell–transfused recipients

“…Additional studies may be needed to directly assess smoking exposure through the measurement of cotinine levels in donated RBC units as well as the impact of smoking and other donor factors on RBC recovery and survival studies. 43,44 [Color figure can be viewed at wileyonlinelibrary.com] However, our findings are reassuring that donor tobacco use does not appear to have an effect on recipient outcomes.…”

“…However, we saw no association between donor hemoglobin levels, obesity, or self‐reported smoking status and hospital mortality or length of stay. Additional studies may be needed to directly assess smoking exposure through the measurement of cotinine levels in donated RBC units as well as the impact of smoking and other donor factors on RBC recovery and survival studies . However, our findings are reassuring that donor tobacco use does not appear to have an effect on recipient outcomes.…”

“…Additional studies may be needed to directly assess smoking exposure through the measurement of cotinine levels in donated RBC units as well as the impact of smoking and other donor factors on RBC recovery and survival studies. 43,44 Fig. 5.…”