Restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants: A systematic review and meta‐analysis

Ibrahim, Masitah; Ho, Selina Kah Ying; Yeo, Cheo Lian

doi:10.1111/jpc.12409

Cited by 29 publications

(22 citation statements)

References 43 publications

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“…In 2014, Ibrahim et al . performed a meta‐analysis which reflects the results of the Cochrane review. These partly contradicting results highlight the need for more studies and clearer evidence to reach global consensus on transfusion thresholds and improve neonatal care .…”

Section: Discussionmentioning

confidence: 99%

“…In the Cochrane systematic review, Whyte and Kirpalani [11] concluded that the use of restrictive as compared to liberal transfusion guidelines resulted in modest reductions in exposure to transfusion, without a significant impact on death or major morbidities. In 2014, Ibrahim et al [24] performed a meta-analysis which reflects the results of the Cochrane review. These partly contradicting results highlight the need for more studies and clearer evidence to reach global consensus on transfusion thresholds and improve neonatal care [2,25].…”

Section: Discussionmentioning

confidence: 99%

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Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change

et al. 2018

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Objective To evaluate red blood cell (RBC) transfusion practices in preterm neonates before and after protocol change. Methods All preterm neonates (<32 weeks of gestation) admitted between 2008 and 2017 at our neonatal intensive care unit were included in this retrospective study. Since 2014, a more restrictive transfusion guideline was implemented in our unit. We compared transfusion practices before and after this guideline change. Primary outcome was the number of transfusions per neonate and the percentage of neonates receiving a blood transfusion. Secondary outcomes were neonatal morbidities and mortality during admission. Results The percentage of preterm neonates requiring a blood transfusion was 37·5% (405/1079) before and 32·7% (165/505) after the protocol change (P = 0·040). The mean number of transfusions given to each transfused neonate decreased from 2·93 (standard deviation (SD) ± 2·26) to 2·20 (SD ±1·29) (P = 0·007). We observed no association between changes in transfusion practices and neonatal outcome. Conclusion The use of a more restrictive transfusion guideline leads to a reduction in red blood cell transfusions in preterm neonates, without evidence of an increase in mortality or short‐term morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change

et al. 2018

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“…Strategies for limiting TRIM and detrimental proinflammatory effects of RBC transfusions have been investigated, but the use of leukoreduction has given contradictory clinical results . The recent ARIPI study failed to demonstrate improved outcomes from the use of fresh RBCs (≤7 days old) in very low birthweight infants, and a restrictive RBC transfusion policy has not been found to decrease the risk of TANEC . Thus, care and caution in prescribing RBC transfusions following shared guidelines seems to be the most powerful approach to create benefits without detrimental effects from RBC transfusional therapy.…”

Section: Discussionmentioning

confidence: 99%

Red blood cell transfusions can induce proinflammatory cytokines in preterm infants

Dani¹,

Poggi²,

Gozzini³

et al. 2017

Transfusion

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BACKGROUND The risk of developing red blood cell (RBC) transfusion–associated necrotizing enterocolitis (TANEC) in preterm infants has recently been emphasized. Our aim was to assess changes in cytokine serum levels after RBC transfusions in a cohort of very preterm infants to evaluate their possible proinflammatory effect. STUDY DESIGN AND METHODS We carried out a prospective observational study. One transfusion event was studied in infants less than 32 weeks' gestation and more than 7 days old (n = 20) admitted to a tertiary neonatal intensive care unit. Interleukin (IL)−1β, IL‐6, IL‐8, tumor necrosis factor‐α, interferon‐γ (IFN‐γ), IL‐17, monocyte chemoattractant protein‐1 (MCP‐1), interferon‐γ–induced protein 10 (IP‐10), intracellular adhesion molecule‐1 (ICAM‐1), and vascular cell adhesion molecule serum levels were measured in enrolled patients within 120 minutes before (T0) the RBC transfusion and then within 120 minutes (T1), 12 ± 3 hours (T2), 24 ± 6 hours (T3), and 48 ± 6 hours (T4) after the end of RBC transfusion. RESULTS Infants received 19.8 ± 3.0 mL of RBCs at the mean age of 50 ± 18 days. Their hematocrit level increased from 24.1 ± 1.2% to 39.4 ± 2.9%. IL‐1β, IL‐8, IFN‐γ, IL‐17, MCP‐1, IP‐10, and ICAM‐1 increased significantly after RBC transfusions. CONCLUSION Proinflammatory cytokines are increased after RBC transfusion. These findings may contribute to explaining the pathogenesis of TANEC and suggest the opportunity of adopting wise transfusion guidelines that would help to avoid detrimental risks of transfusion‐related immunomodulation and of undertransfusion.

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“…These findings are consistent with most previously published meta-analyses. [6,8,26,27] However, unlike the latter reports, we pooled data only from randomized trials assessing adult hip or knee surgery patients that compared restrictive and liberal transfusion thresholds. The clinical settings and thresholds for blood transfusion were similar in all the trials included in the current meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Restrictive versus liberal transfusion strategies for red blood cell transfusion after hip or knee surgery

Mao

Gao²,

Han³

et al. 2017

Medicine

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Background:Red blood cell (RBC) transfusions are commonly used in surgical patients, but accompanied by many risks such as metabolic derangement, and allergic and febrile reactions. Indications for transfusion in patients after hip or knee surgery have not been definitively evaluated and remain controversial. We performed a meta-analysis to compare the benefits and harms of restrictive versus liberal transfusion strategies in patients after hip or knee surgery.Methods:The PubMed, EMBASE, and Cochrane Library databases were searched for relevant studies through September 2015. The main clinical outcomes reported in randomized controlled trials (RCTs) included 30-day mortality, infection rate, cardiogenic complications, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I2 test. Begg and Egger test were used to assess potential publication bias.Results:We identified 10 eligible RCTs, involving 3788 patients in total. In patients undergoing hip or knee surgery, we found no differences in mortality, or the incidence rates of pneumonia, wound infection, myocardial infarction, or congestive heart failure, between restrictive and liberal thresholds for RBC transfusion (P > .05).Conclusion:Restrictive transfusion has no advantage over the liberal strategy. However, considerably less patients received blood transfusion via the restrictive strategy than with the liberal counterpart. Due to variations in the included studies, additional larger scale and well-designed studies are required to validate these conclusions.

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Restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants: A systematic review and meta‐analysis

Abstract: Restrictive RBC transfusion thresholds in VLBW infants may be utilised without incurring clinically important increases in the risk of death or major short-term neonatal morbidities.

Cited by 29 publications

References 43 publications

Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change

Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change

Red blood cell transfusions can induce proinflammatory cytokines in preterm infants

Restrictive versus liberal transfusion strategies for red blood cell transfusion after hip or knee surgery

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