BACKGROUND: Very preterm infants commonly develop anemia requiring multiple red blood cell transfusions (RBCTx). This is in part attributable to heavy laboratory phlebotomy loss. Quantification of the extent to which laboratory blood loss contributes to anemia sufficient to prompt RBCTx has not been examined. STUDY DESIGN AND METHODS: Twenty-six preterm infants weighing less than 1500 g at birth requiring ventilator support who received one or more RBCTx were intensively studied during the first month of life. Hemoglobin (Hb) loss via laboratory blood loss and RBC senescence and Hb gain from RBCTx were precisely accounted for in a Hb mass balance mathematical model developed to assess the impact of phlebotomy on RBCTx when restrictive RBCTx criteria were applied. RESULTS: Study subjects had a birth weight of 880 ± 240 g (mean ± SD) and a Hb level of 14.4 ± 2.4 g/dL at birth and received 3.81 ± 2.15 RBCTx during the study period. Modeling indicated that even with the total elimination of laboratory phlebotomy loss, a reduction of 41% to 48% in RBCTx was achievable. CONCLUSION: The present modeling results indicate that while phlebotomy reduction can significantly decrease the number of RBCTx administered to preterm infants, total elimination of all RBCTx will likely require other approaches, for example, stimulation of erythropoiesis with erythropoiesis-stimulating agents.
BACKGROUND: Very preterm infants commonly develop anemia requiring multiple red blood cell transfusions (RBCTx). This is in part attributable to heavy laboratory phlebotomy loss. Quantification of the extent to which laboratory blood loss contributes to anemia sufficient to prompt RBCTx has not been examined. STUDY DESIGN AND METHODS: Twenty-six preterm infants weighing less than 1500 g at birth requiring ventilator support who received one or more RBCTx were intensively studied during the first month of life. Hemoglobin (Hb) loss via laboratory blood loss and RBC senescence and Hb gain from RBCTx were precisely accounted for in a Hb mass balance mathematical model developed to assess the impact of phlebotomy on RBCTx when restrictive RBCTx criteria were applied. RESULTS: Study subjects had a birth weight of 880 ± 240 g (mean ± SD) and a Hb level of 14.4 ± 2.4 g/dL at birth and received 3.81 ± 2.15 RBCTx during the study period. Modeling indicated that even with the total elimination of laboratory phlebotomy loss, a reduction of 41% to 48% in RBCTx was achievable. CONCLUSION: The present modeling results indicate that while phlebotomy reduction can significantly decrease the number of RBCTx administered to preterm infants, total elimination of all RBCTx will likely require other approaches, for example, stimulation of erythropoiesis with erythropoiesis-stimulating agents.
Authors: Aryeh Shander; Axel Hofmann; Sherri Ozawa; Oliver M Theusinger; Hans Gombotz; Donat R Spahn Journal: Transfusion Date: 2009-12-09 Impact factor: 3.157
Authors: John A Widness; Ashima Madan; Ligia A Grindeanu; M Bridget Zimmerman; David K Wong; David K Stevenson Journal: Pediatrics Date: 2005-05 Impact factor: 7.124
Authors: Edward F Bell; Ronald G Strauss; John A Widness; Larry T Mahoney; Donald M Mock; Victoria J Seward; Gretchen A Cress; Karen J Johnson; Irma J Kromer; M Bridget Zimmerman Journal: Pediatrics Date: 2005-06 Impact factor: 7.124
Authors: Ronald G Strauss; Donald M Mock; John A Widness; Karen Johnson; Gretchen Cress; Robert L Schmidt Journal: Transfusion Date: 2004-06 Impact factor: 3.157
Authors: Patrick D Carroll; M Bridget Zimmerman; Demet Nalbant; Earl L Gingerich; Guohua An; Gretchen A Cress; Peter Veng-Pedersen; John A Widness Journal: Neonatology Date: 2020-06-19 Impact factor: 4.035
Authors: Raeda T Al-Ghananim; Demet Nalbant; Robert L Schmidt; Gretchen A Cress; M Bridget Zimmerman; John A Widness Journal: J Clin Lab Anal Date: 2015-05-13 Impact factor: 2.352
Authors: Matthew R Rosebraugh; John A Widness; Demet Nalbant; Gretchen Cress; Peter Veng-Pedersen Journal: Pediatr Res Date: 2013-11-11 Impact factor: 3.756
Authors: Osayame A Ekhaguere; Frank H Morriss; Edward F Bell; Nadkarni Prakash; John A Widness Journal: Pediatr Res Date: 2016-01-12 Impact factor: 3.756