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Randomized trial assessing the feasibility and safety of biologic parents as RBC donors for their preterm infants
R G Strauss1, L F Burmeister, K Johnson
1Department of Pediatrics, Preventive Medicine and Environmental Health, and Pathology, The University of Iowa College of Medicine, Iowa City, IA 52242-1182, USA. strauss@uiowa.edu
Insights
Single-donor programs using red blood cells (RBCs) from parents or unrelated donors are safe for preterm infants. This approach minimizes donor exposure, enhancing transfusion safety for neonates requiring RBC transfusions.
Area of Science:
- Neonatal Medicine
- Transfusion Medicine
- Pediatric Hematology
Background:
- Very low birth weight infants often require red blood cell (RBC) transfusions.
- RBCs stored up to 42 days can be safely transfused in small volumes to preterm infants, reducing donor exposure.
- Concerns exist regarding potential serological incompatibility between biologic parents and their infants.
Purpose of the Study:
- To compare the feasibility and immediate safety of two single-donor programs for small-volume RBC transfusions in preterm infants.
- To evaluate RBC transfusions from unrelated donors versus biologic parents.
- To assess adverse effects and laboratory abnormalities associated with these transfusion programs.
Main Methods:
- A randomized study comparing two single-donor RBC transfusion programs for preterm infants.
- Infants received either RBCs from unrelated donors or from their biologic parents, stored up to 42 days in AS-3.
- All transfusions were standardized (15 mL/kg over 5 hours) with close clinical and laboratory monitoring.
Main Results:
- Biologic parents faced some donor eligibility challenges but could meet their infants' transfusion needs.
- No significant differences in clinical transfusion reactions or laboratory abnormalities were observed between the two donor groups.
- Adverse effects were rare and clinically insignificant, irrespective of the RBC donor source.
Conclusions:
- Single-donor programs using AS-3 RBCs stored up to 42 days are feasible and safe for preterm infants.
- Biologic parents can be considered as blood donors for their infants in single-donor systems.
- Limiting donor exposure through single-donor programs likely enhances transfusion safety by reducing infectious disease transmission risk.
Background:
Most very low birth weight (<1.0 kg) infants receive RBC transfusions. Several reports have demonstrated that RBCs stored up to 42 days can be transfused safely in small volumes to preterm infants to decrease donor exposure without consequent hyperkalemia, acidosis, or other adverse effects. Although biologic parents are likely candidates as donors of blood for their neonates, it has been suggested that their blood may be serologically incompatible with that of their infants.
Study Design And Methods:
A two-arm randomized study was conducted to compare the feasibility and immediate safety of two single-donor programs for providing small-volume RBC transfusions to preterm infants: in one arm, infants received RBCs collected from unrelated donors and stored up to 42 days, and in the other arm, RBCs were collected from one of the biologic parents and stored identically. All infants received compatible RBCs that were WBC reduced before storage, stored in AS-3, and gamma-radiated. All transfusions were given uniformly as 15 mL per kg of RBCs transfused over 5 hours, during which time the infants were closely observed for clinical reactions. In addition, laboratory studies were performed shortly before and after each transfusion.
Results:
A total of 40 preterm infants received 120 RBC transfusions. Biologic parents experienced several donor eligibility problems. However, once enrolled as donors, they were able to supply all RBCs needed by their infants. Significant differences in rates of clinical transfusion reactions and laboratory abnormalities were rare and had no apparent clinical importance, regardless of whether RBCs were donated by biologic parents or unrelated donors.
Conclusion:
A single-donor system, in which AS-3 RBCs were collected either from unrelated blood donors or from biologic parents and then stored up to 42 days, was able to supply small-volume RBC transfusions needed by individual preterm infants without immediate, adverse effects. Because the risk of infectious disease transmission is likely reduced by limiting donor exposure, it is logical to conclude that single-donor programs should increase transfusion safety and that biologic parents should be considered as blood donors for their infants.
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