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Updated: May 4, 2026
Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
Methylglyoxal concentrations differ in standard and washed neonatal packed red blood cells
Autumn S Kiefer1, Thomas Fleming2, George J Eckert3
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
High glucose in red blood cell (RBC) storage may increase harmful methylglyoxal (MG) in transfusions for preterm infants. Washing RBCs reduced MG and D-lactate, potentially mitigating damage and inflammation.
Area of Science:
- Biochemistry
- Neonatal Medicine
- Blood Transfusion
Background:
- Preterm infants undergoing transfusion face increased risk of necrotizing enterocolitis.
- High glucose in red blood cell (RBC) preservatives may elevate methylglyoxal (MG) metabolism.
- This could lead to glycation damage in transfused RBCs, potentially causing inflammation.
Purpose of the Study:
- To investigate methylglyoxal (MG) metabolism in standard and washed RBCs during neonatal storage.
- To assess the impact of storage duration and washing on MG, glucose, and related metabolites.
- To explore the potential link between MG levels in transfused RBCs and adverse outcomes in preterm neonates.
Main Methods:
- Analyzed standard and washed RBCs (Adsol-3) over 42 days of storage.
- Measured glucose, methylglyoxal (MG), reduced glutathione, glyoxalase I (GLO-I) activity, and D-lactate.
- Consecutive measurements were performed throughout the storage period.
Main Results:
- RBC units consumed glucose and produced D-lactate and MG during storage.
- Most units (28/30) showed stable MG levels; two units had elevated MG early in storage.
- Washing RBCs significantly reduced both MG and D-lactate concentrations.
Conclusions:
- Observed two distinct patterns of MG metabolism in packed RBCs for neonatal transfusion.
- Elevated MG levels in RBC units may correlate with increased glycation-driven damage.
- Further research is needed to confirm if transfused MG triggers necrotizing enterocolitis and if washing prevents this.
Background:
Preterm infants have a greater risk of necrotizing enterocolitis following transfusion. It is hypothesized that high glucose concentrations in red blood cell (RBC) preservatives lead to increased methylglyoxal (MG) metabolism, causing glycation-driven damage to transfused RBCs. Such changes to the RBCs could promote a proinflammatory state in transfusion recipients.
Methods:
Standard and washed RBCs in Adsol-3, two common neonatal preparations, were studied. Consecutive measurements were performed of glucose, MG, reduced glutathione, glyoxalase I activity (GLO-I), and D-lactate, the stable end product of MG detoxification by glyoxalase enzymes over the 42-d storage period.
Results:
RBC units consume glucose and produceD-lactate and MG during storage. In 28/30 units, the MG concentrations showed only small variations during storage. Two units had elevated MG levels (>10 pmol/mg Hb) during the first half of storage. Washing of the RBCs significantly reduced both MG and D-lactate.
Conclusion:
This study shows two patterns of MG metabolism in packed RBCs for neonatal transfusion and raises the possibility that RBC units with higher MG levels may have increased glycation-driven damage in the transfused RBCs. Whether transfused MG could trigger an inflammatory response such as necrotizing enterocolitis in preterm neonates and whether washing could prevent this require further study.
