The contribution of red blood cell transfusion to neonatal morbidity and mortality

Abstract

Anaemia of prematurity will affect 90% of all very preterm infants, resulting in at least one red blood cell (RBC) transfusion. A significant proportion of preterm infants require multiple transfusions over the course of hospital admission. Growing evidence supports an association between transfusion exposure and adverse neonatal outcomes. In adults, transfusion‐associated sepsis, transfusion‐related acute lung injury and haemolytic reactions are the leading causes of transfusion‐related morbidity and mortality; however, these are seldom recognised in newborns. The association between transfusion and adverse outcomes remains inconclusive. However, the evidence from preclinical studies demonstrates that RBC products can directly modulate immune cell function, a pathway termed transfusion‐related immunomodulation (TRIM), which may provide a mechanism linking transfusion exposure with neonatal morbidities. Finally, we discuss the impact of TRIM on transfusion medicine, how we may address these issues and the emerging areas of research aimed at improving the safety of transfusions in this vulnerable population.

Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

“…Several studies support a close association between transfusions and neonatal morbidity and mortality. [14][15][16][17][18][19][20] An evident result of top-up transfusions in preterm infants is that fetal haemoglobin, which should be physiologically high at this stage of life, is progressively replaced by adult haemoglobin. 21 In general, severely ill neonates are likely to receive a greater number of blood products, so that the causality between transfusions and negative outcomes is difficult to be ascertained in retrospective and prospective analyses.…”

“…The median HbF estimates are shown in the lower section of Table III. Overall, 465 HbF measurements were included in the analysis, corresponding to an average of 20 determinations per patient (IQR [16][17][18][19][20][21][22]. Cord-RBCs and adult-RBCs transfusions elicited significantly different HbF values (P < 0Á0001).…”

Effect of red blood cell transfusion on the development of retinopathy of prematurity: A systematic review and meta-analysis

“…Reports have found that approximately 90% of extremely low birth weight (ELBW) infants receive at least one RBC transfusion [3]. In general, RBC transfusion is able to improve anemia, increase tissue oxygenation, promote growth and reduce mortality [4,5]. However, considerable evidence suggests that RBC transfusion is related to several preterm disorders, including the development of ROP [5].…”

Red cell alloimmunization: A 2020 update

“…Long‐term neurodevelopmental and cardiac outcomes after IUT have been evaluated by Lindenburg et al in a review published in Prenatal Diagnosis . Blood transfusion may be an independent predictor of adverse neonatal outcomes and transfusion‐related immunomodulation and the effect of cofactors transfused with blood products are receiving research attention . Echocardiography has demonstrated reduced left ventricular mass in children followed up at a median age of 10 years following IUT for alloimmune anemia .…”