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Red blood transfusion in preterm infants: changes in glucose, electrolytes and acid base balance
Shereen Abdelghaffar1, Yasmeen Mansi, Reem Ibrahim
1Department of Pediatrics, Cairo University, Cairo, Egypt.
Insights
Red blood cell (RBC) transfusions improve anemia and oxygenation in preterm infants but can cause hyperkalemia, particularly in those with borderline high potassium levels. Careful monitoring is essential for metabolic balance.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Clinical Biochemistry
Background:
- Preterm neonates, especially those with extremely low birth weight, frequently require red blood cell (RBC) transfusions.
- Approximately 85% of these infants receive transfusions during their hospital stay.
Purpose of the Study:
- To evaluate the metabolic effects of RBC transfusions in preterm infants within the first two weeks of life.
- To assess the relationship between transfusion volume and metabolic changes.
Main Methods:
- Study included 40 preterm neonates (gestational age ≤ 34 weeks) receiving RBC transfusions.
- Blood samples were analyzed pre- and post-transfusion for hemoglobin, hematocrit, acid-base status, electrolytes, and glucose.
- Infants were categorized by transfusion volume: <20 ml/kg or >20 ml/kg.
Main Results:
- Transfusion significantly increased hemoglobin, hematocrit, pH, and pO2, while decreasing pCO2.
- Serum potassium (K+) increased significantly, and calcium (Ca+2) decreased significantly post-transfusion.
- Higher transfusion volumes correlated with greater increases in hemoglobin/hematocrit and greater decreases in serum calcium.
Conclusions:
- RBC transfusions effectively correct anemia and improve oxygenation in preterm infants.
- Transfusions can lead to significant metabolic shifts, including hyperkalemia and hypocalcemia, with volume-dependent effects on calcium levels.
- Hyperkalemia development is a key concern, especially in infants with pre-existing borderline hyperkalemia.
Background:
Preterm neonates comprise the most heavily transfused group of patients, and about 85% of extremely low birth weight newborns receive a transfusion by the end of their hospital stay. The aim of this study was to assess the possible metabolic effects of RBC transfusion on preterm infants, especially during the first 2 weeks of life, and its relation to blood volume.
Materials And Methods:
This study was conducted on 40 preterm neonates with gestational age of less than or equal to 34 weeks. They received RBCs transfusion during first 2 weeks of life. Venous blood samples of infants were collected 2 to 4 hours before and 1 hour after the end of transfusion to evaluate hemoglobin (Hb) level, hematocrit, acid-base, electrolytes, and glucose status. Then, infants were classified into two main groups: those who received RBCs volume less than or 20 ml/kg and those who received RBCs volume more than 20 ml/kg.
Results:
Infants received a mean volume of 20.38 ± 3.2 ml/kg RBCs (range, 10.9 - 26.6 ml/kg) at a median age of 9.8 ± 3.6 days. After transfusion, a significant increase of mean Hb (P<0.001), mean Hct (P<0.001), pH (P<0.001), pO(2) (P<0.05), and a significant decrease of the pCO2 (41.46 ± 8.8torr vs 35.4 ± 9.34 torr; P<0.001) were observed. In addition, there was a significant increase of serum K(+) (P<0.001), and a significant decrease of Ca(+2) (P<0.001). A positive correlation was found between the K(+) intake and the changes of kalemia (r = 0.99; P = 0.00). Furthermore, we observed an inverse correlation between the patients' calcium intake and the changes of calcemia (r = -0.35; P = 0.02). On comparing the changes in clinical and biochemical variables between two groups after transfusion, we observed a significant increase in mean Hb and Hct associated with a significant decrease in mean serum Ca(+2) (P<0.001) in the group receiving the larger blood volume.
Conclusion:
RBC transfusion was effective in improving anemia, oxygenation, increasing pH, and decreasing CO(2) and Ca(+2). However, from a more clinically relevant point of view, we demonstrated the development of hyperkalemia, especially in infants with a previously borderline hyperkalemia.
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