How I transfuse red blood cells and platelets to infants with the anemia and thrombocytopenia of prematurity
- 8 January 2008
- journal article
- Published by Wiley in Transfusion
- Vol. 48 (2), 209-217
- https://doi.org/10.1111/j.1537-2995.2007.01592.x
Abstract
Many aspects of hematopoiesis are either incompletely developed in preterm infants or still functioning to serve the fetus (i.e., the intrauterine counterpart to a liveborn preterm neonate). This delayed development and/or slow adaptation to extrauterine life diminishes the capacity of the neonate to produce red blood cells (RBCs), platelets (PLTs), and neutrophils—particularly during the stress of life-threatening illnesses encountered after preterm birth such as sepsis, severe pulmonary dysfunction, necrotizing enterocolitis, and immune cytopenias. The serious medical and/or surgical problems of preterm birth can be further complicated by phlebotomy blood losses, bleeding, hemolysis, and consumptive coagulopathy. To illustrate, some preterm infants, especially those with birth weight less than 1.0 kg and respiratory distress, are given numerous RBC transfusions early in life owing to several interacting factors. Neonates delivered before 28 weeks of gestation (birth weight, <1.0 kg) are born before the bulk of iron transport has occurred from mother to fetus via the placenta and before the onset of marked erythropoietic activity of fetal marrow during the third trimester. Soon after preterm birth, severe respiratory disease can lead to repeated blood sampling for laboratory studies and, consequently, to replacement RBC transfusions. Additionally, preterm infants are unable to mount an effective erythropoietin (EPO) response to decreasing numbers of RBCs, and this factor contributes to the diminished ability to compensate for anemia—thus enhancing need for RBC transfusions.Keywords
This publication has 53 references indexed in Scilit:
- Differential effects of recombinant thrombopoietin and bone marrow stromal-conditioned media on neonatal versus adult megakaryocytesBlood, 2006
- 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 infantsThe Journal of Pediatrics, 2006
- Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients?*Critical Care Medicine, 2004
- A randomized, controlled trial of platelet transfusions in thrombocytopenic premature infantsThe Journal of Pediatrics, 1993
- Effect of booster blood transfusions on oxygen utilization in infants with bronchopulmonary dysplasiaThe Journal of Pediatrics, 1988
- Responsiveness to recombinant human erythropoietin of marrow erythroid progenitors from infants with the “anemia of prematurity”The Journal of Pediatrics, 1988
- Clinical impact of neonatal thrombocytopeniaThe Journal of Pediatrics, 1987
- Frequency and mechanism of neonatal thrombocytopeniaThe Journal of Pediatrics, 1986
- Anemia of prematurity: Determinants of the erythropoietin responseThe Journal of Pediatrics, 1984
- Decreased response of plasma immunoreactive erythropoietin to “available oxygen” in anemia of prematurityThe Journal of Pediatrics, 1984