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-birthweight (VLBW) neonates (birthweight ≤ 1.5 kg) frequently develop anemia that is treated with red blood cell (RBC) transfusions. Although RBCs transfused to adults demonstrate progressive decreases in posttransfusion 24-hour RBC recovery (PTR24 ) during storage-to a mean of approximately 85% of the Food and Drug Administration-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 not more than 42 days in AS-3 or AS-5. PTR24 was determined in 46 VLBW neonates using biotin-labeled RBCs and in 76 healthy adults using 51 Cr-labeled RBCs. 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-day 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.

Trial registration: ClinicalTrials.gov NCT00731588.

Conflict of interest statement

Conflict of Interest Statements:

Demet Nalbant: Nothing to declare.

Jose A. Cancelas: Nothing to declare.

Donald M Mock: Paid consultant for Medday Pharmaceuticals

Svetlana V. Kyosseva: Nothing to declare.

Robert L. Schmidt: Nothing to declare.

Nell I. Mathews: Nothing to declare.

Gretchen A. Cress: Nothing to declare.

M. Bridget Zimmerman: Nothing to declare.

Ronald G. Strauss: Nothing to declare.

John A. Widness: Has established loan agreement for use of a Sysmex Hematology Analyzer

© 2017 AABB.

Figures

Figure 1

24-hr post-transfusion recovery decreases with duration of storage for adults (n=86) but not for infants (n=42). Slope of the linear regression for healthy adults (black solid line) significantly differed from zero (P51Cr-labeled BioRBCs): Low BioRBC density (gray dotted line); Medium BioRBC density (gray solid line); and High BioRBC density (black dashed line).