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Are single-donor red blood cell transfusions still relevant for preterm infants?

Abstract

Objective

To explore the worth of a single-donor program for preterm infants through the recipient profile and the impact on donor exposure, red blood cell (RBC) pack waste, storage duration, and transfusion performance.

Study design

Patients and transfusion characteristics were collected for 3 years (2015–2017) in preterm infants according to single-donor program prescription in a unit not practicing placental transfusion or erythropoietin supplementation.

Results

Among 1048 eligible preterm infants, 161 met the inclusion criteria, and 51 received single-donor packs. Our single-donor program induced a donor number reduction (34% less than the transfusion number) and an extension of storage duration (median: 9 versus 7 days, p < 0.0001) without altering the transfusion performance. However, 41% of small packs were not used.

Conclusion

A single-donor program partially reduced donor exposure but led to drastic RBC pack waste. Optimization of transfusion alternatives may increase this phenomenon, calling into question the rationale of this practice.

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Fig. 1: RBC pack storage duration according to the single-donor program.
Fig. 2: RBC transfusion performance according to storage duration.

References

  1. 1.

    Hosono S, Mugishima H, Shimada M, Minato M, Okada T, Takahashi S, et al. Prediction of transfusions in extremely low-birthweight infants in the erythropoietin era. Pediatr Int J Jpn Pediatr Soc. 2006;48:572–6.

    Article  Google Scholar 

  2. 2.

    Dollat C, Pierron C, Keslick A, Billoir E, François A, Jarreau P-H. [Single-donor protocol: transfusion practices and multiple transfusion risk factors in neonatal intensive care unit].Arch Pediatr Organe Off Soc Francaise Pediatr. 2016;23:935–43.

    CAS  Google Scholar 

  3. 3.

    Ekhaguere OA, Morriss FH, Bell EF, Prakash N, Widness JA. Predictive factors and practice trends in red blood cell transfusions for very-low-birth-weight infants. Pediatr Res. 2016;79:736–41.

    CAS  Article  Google Scholar 

  4. 4.

    Aher SM, Ohlsson A. Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2014;4:CD004868.

    Google Scholar 

  5. 5.

    Maier RF, Obladen M, Scigalla P, Linderkamp O, Duc G, Hieronimi G, et al. The effect of epoetin beta (recombinant human erythropoietin) on the need for transfusion in very-low-birth-weight infants. European Multicentre Erythropoietin Study Group. N. Engl J Med. 1994;330:1173–8.

    CAS  Article  Google Scholar 

  6. 6.

    Liu EA, Mannino FL, Lane TA. Prospective, randomized trial of the safety and efficacy of a limited donor exposure transfusion program for premature neonates. J Pediatr. 1994;125:92–96.

    CAS  Article  Google Scholar 

  7. 7.

    Khodabux CM, von Lindern JS, van Hilten JA, Scherjon S, Walther FJ, Brand A. A clinical study on the feasibility of autologous cord blood transfusion for anemia of prematurity. Transfusion. 2008;48:1634–43.

    Article  Google Scholar 

  8. 8.

    Wood A, Wilson N, Skacel P, Thomas R, Tidmarsh E, Yale C, et al. Reducing donor exposure in preterm infants requiring multiple blood transfusions. Arch Dis Child Fetal Neonatal Ed. 1995;72:F29–33.

    CAS  Article  Google Scholar 

  9. 9.

    Lee DA, Slagle TA, Jackson TM, Evans CS. Reducing blood donor exposures in low birth weight infants by the use of older, unwashed packed red blood cells. J Pediatr. 1995;126:280–6.

    CAS  Article  Google Scholar 

  10. 10.

    Mangel J, Goldman M, Garcia C, Spurll G. Reduction of donor exposures in premature infants by the use of designated adenine-saline preserved split red blood cell packs. J Perinatol J Calif Perinat Assoc. 2001;21:363–7.

    CAS  Google Scholar 

  11. 11.

    International Society of Blood Transfusion. Code of ethics relating to transfusion medecine. 2017. https://www.isbtweb.org/fileadmin/user_upload/ISBT_Code_Of_Ethics_English.pdf. Accessed 27 Oct 2019.

  12. 12.

    Whyte R, Kirpalani H. Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. Cochrane Database Syst Rev. 2011;11:CD000512.

    Google Scholar 

  13. 13.

    Strauss RG, Cordle DG, Quijana J, Goeken NE. Comparing alloimmunization in preterm infants after transfusion of fresh unmodified versus stored leukocyte-reduced red blood cells. J Pediatr Hematol Oncol. 1999;21:224–30.

    CAS  Article  Google Scholar 

  14. 14.

    Chassé M, McIntyre L, English SW, Tinmouth A, Knoll G, Wolfe D, et al. Effect of blood donor characteristics on transfusion outcomes: a systematic review and meta-analysis. Transfus Med Rev. 2016;30:69–80.

    Article  Google Scholar 

  15. 15.

    Fernandes da Cunha DH, Nunes Dos Santos AM, Kopelman BI, Areco KN, Guinsburg R, de Araújo Peres C, et al. Transfusions of CPDA-1 red blood cells stored for up to 28 days decrease donor exposures in very low-birth-weight premature infants. Transfus Med Oxf Engl. 2005;15:467–73.

    CAS  Article  Google Scholar 

  16. 16.

    Fergusson DA, Hébert P, Hogan DL, LeBel L, Rouvinez-Bouali N, Smyth JA, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. JAMA. 2012;308:1443–51.

    CAS  Article  Google Scholar 

  17. 17.

    Strauss RG, Mock DM, Widness JA, Johnson K, Cress G, Schmidt RL. Posttransfusion 24-hour recovery and subsequent survival of allogeneic red blood cells in the bloodstream of newborn infants. Transfusion. 2004;44:871–6.

    Article  Google Scholar 

  18. 18.

    Nalbant D, Cancelas JA, Mock DM, Kyosseva SV, Schmidt RL, Cress GA, et al. In premature infants there is no decrease in 24-hour posttransfusion allogeneic red blood cell recovery after 42 days of storage. Transfusion. 2018;58:352–8.

    CAS  Article  Google Scholar 

  19. 19.

    Keir AK, McPhee AJ, Andersen CC, Stark MJ. Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant. Pediatr Res. 2013;73:75–79.

    CAS  Article  Google Scholar 

  20. 20.

    Dani C, Poggi C, Gozzini E, Leonardi V, Sereni A, Abbate R, et al. Red blood cell transfusions can induce proinflammatory cytokines in preterm infants. Transfusion. 2017;57:1304–10.

    CAS  Article  Google Scholar 

  21. 21.

    Kalhan TG, Bateman DA, Bowker RM, Hod EA, Kashyap S. Effect of red blood cell storage time on markers of hemolysis and inflammation in transfused very low birth weight infants. Pediatr Res. 2017;82:964–9.

    Article  Google Scholar 

  22. 22.

    Kiefer AS, Fleming T, Eckert GJ, Poindexter BB, Nawroth PP, Yoder MC. Methylglyoxal concentrations differ in standard and washed neonatal packed red blood cells. Pediatr Res. 2014;75:409–14.

    CAS  Article  Google Scholar 

  23. 23.

    Stark MJ, Keir AK, Andersen CC. Does non-transferrin bound iron contribute to transfusion related immune-modulation in preterms? Arch Dis Child Fetal Neonatal Ed. 2013;98:F424–429.

    Article  Google Scholar 

  24. 24.

    Hauck-Dlimi B, Braun T, Eckstein R, Strobel J, Zimmermann R. Influence of early irradiation on in vitro red blood cell (RBC) storage variables of leucoreduced RBCs in additive solution SAG-M. Vox Sang. 2016;110:362–8.

    CAS  Article  Google Scholar 

  25. 25.

    Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics. 2005;115:1685–91.

    Article  Google Scholar 

  26. 26.

    Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, et al. The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr. 2006;149:301–7.

    Article  Google Scholar 

  27. 27.

    Ohlsson A, Aher SM. Early erythropoiesis-stimulating agents in preterm or low birth weight infants. Cochrane Database Syst Rev. 2017;11:CD004863.

    PubMed  Google Scholar 

  28. 28.

    Aher SM, Ohlsson A. Late erythropoiesis-stimulating agents to prevent red blood cell transfusion in preterm or low birth weight infants. Cochrane Database Syst Rev. 2019;2:CD004868.

    PubMed  Google Scholar 

  29. 29.

    Tarnow-Mordi W, Morris J, Kirby A, Robledo K, Askie L, Brown R, et al. Delayed versus Immediate Cord Clamping in Preterm Infants. N. Engl J Med. 2017;377:2445–55.

    Article  Google Scholar 

  30. 30.

    Rosebraugh MR, Widness JA, Nalbant D, Veng-Pedersen P. A mathematical modeling approach to quantify the role of phlebotomy losses and need for. Transfus Neonatal Anemia Transfus. 2013;53:1353–60.

    Google Scholar 

  31. 31.

    Dos Santos AMN, Guinsburg R, de Almeida MFB, Procianoy RS, Marba STM, Ferri WAG, et al. Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units. BMC Pediatr. 2015;15:113.

    Article  Google Scholar 

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Author information

Affiliations

Authors

Contributions

GF designed the study protocol, obtained ethics approval, performed preliminary and final data analysis and wrote the paper. EG actively participated in patient screening and enrollment, participated in preliminary and final data analysis and contributed to the writing of the paper. BH and J-YP provided RBC pack information (i.e., RBC pack identification, RBC pack volume and storage duration) and contributed to the writing and critical reading of the paper. ES contributed to the writing and critical reading of the paper.

Corresponding author

Correspondence to Geraldine Favrais.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Gouache, E., Py, JY., Hérault, B. et al. Are single-donor red blood cell transfusions still relevant for preterm infants?. J Perinatol 40, 1075–1082 (2020). https://doi.org/10.1038/s41372-020-0670-9

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