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Postnatal changes in fetal hemoglobin, oxygen affinity and 2,3-diphosphoglycerate in previously transfused preterm
Insights
Frequent blood transfusions in preterm infants can temporarily increase fetal hemoglobin (HbF%). Higher HbF% was linked to lower oxygen affinity, but unlikely to impact oxygen delivery significantly.
Area of Science:
- Neonatology
- Pediatric Hematology
Background:
- Preterm infants often require frequent blood transfusions.
- The impact of these transfusions on hemoglobin composition and oxygen transport is not fully understood.
Purpose of the Study:
- To investigate the influence of frequent transfusions on fetal hemoglobin (HbF%) levels.
- To determine the effect of post-transfusion HbF% changes on oxygen affinity (P50) in very low birthweight infants.
Main Methods:
- Prospective study of 10 very low birthweight infants.
- Monitoring HbF% and oxygen affinity (P50) after cessation of frequent replacement transfusions.
Main Results:
- A temporary rise in HbF% was observed after transfusion cessation.
- Infants with higher HbF% increases (mean 58%) showed lower oxygen affinity (P50 = 23.3 Torr) compared to those with less increase (mean 29%, P50 = 24.5 Torr).
Conclusions:
- While higher HbF% after transfusions correlates with reduced oxygen affinity, the clinical significance is likely minimal.
- Increased HbF% alone is unlikely to compromise oxygen delivery in preterm infants except under stress.
Abstract:
We observed a temporary rise in the percentage of fetal hemoglobin (HbF%) in small preterm infants after cessation of frequent replacement transfusions. We prospectively studied 10 very low birthweight infants, who received frequent transfusions in the first several weeks of life, to determine the influence on oxygen affinity (P50). After cessation of frequent transfusions, those 5 infants whose HbF% increased to the highest values (mean 58%) had a lower oxygen affinity (P50 = 23.3 Torr, p less than 0.05) than the remaining 5 infants whose increase in HbF% was less marked, to an average of only 29% (P50 = 24.5 Torr). However, in light of the small difference in P50, we feel that a rise in HbF% by itself after a period of frequent transfusions is unlikely to restrict oxygen delivery except under stressful conditions.