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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Multiple red blood cell transfusions and iron overload in very low birthweight infants
J D Treviño-Báez1, E Briones-Lara1, J Alamillo-Velázquez1
1High Specialty Medical Unit No. 23., Hospital of Obstetrics and Gynecology 'Dr. Ignacio Morones Prieto' of the Mexican Institute of Social Security, Monterrey, Nuevo Leon, Mexico.
Insights
Very low birthweight infants receiving more than two red blood cell transfusions face a significantly higher risk of iron overload. Severe iron overload is linked to transfusion volumes exceeding 120 ml/kg.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Clinical Nutrition
Background:
- Very low birthweight (VLBW) infants often require multiple red blood cell (RBC) transfusions.
- Iron accumulation is a potential complication of frequent RBC transfusions in VLBW infants.
- Assessing the risk of iron overload is crucial for managing these vulnerable infants.
Purpose of the Study:
- To compare the risk of iron overload in VLBW infants receiving more than two RBC transfusions versus those receiving two or fewer.
- To identify risk factors associated with iron overload in VLBW infants.
- To determine the transfusion volume threshold associated with severe iron overload.
Main Methods:
- Prospective open cohort study involving VLBW infants categorized by RBC transfusion volume (>2 vs. ≤2).
- Regular measurement of ferritin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels.
- Logistic regression analysis for risk factors and Spearman correlation for transfusion volume and biochemical markers.
Main Results:
- 18 of 63 infants received >2 RBC transfusions; 12 developed severe iron overload.
- Exposed infants had a 5-fold increased risk (RR: 5) of severe iron overload compared to non-exposed.
- Increased transfusion number (OR: 2.07) correlated with higher iron overload risk, while higher one-minute Apgar scores showed a protective effect (OR: 0.56).
- Severe iron overload was primarily observed with total transfusion volumes exceeding 120 ml/kg.
- A significant positive correlation was found between ferritin levels and RBC transfusion volume (r = 0.53, P < 0.001).
Conclusions:
- VLBW infants receiving more than two RBC transfusions have a substantially elevated risk of iron overload.
- A total RBC transfusion volume greater than 120 ml/kg is associated with severe iron overload in VLBW infants.
- Monitoring iron levels and transfusion volumes is critical in VLBW infants receiving multiple RBC transfusions.
Background And Objectives:
To estimate the risk of iron overload in very low birthweight (VLBW) infants who receive more than two red blood cell (RBC) transfusions, in comparison with those who receive two or less during their hospital stay.
Materials And Methods:
Prospective open cohort study in VLBW infants with >2 (exposed) and ≤2 (non-exposed) RBC transfusions. Ferritin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at birth and after each RBC transfusion. The incidence of iron overload was determined. Risk factors were analysed using a logistic regression model. RBC transfusion volume correlations with ferritin, ALT and AST were calculated with Spearman's rank correlation coefficient, as well as correlations between ferritin and aminotransferases.
Results:
A total of 63 patients were enrolled, 18 of which were exposed and 45 non-exposed. Twelve patients developed severe iron overload, eight exposed (44·5%) vs. four (8·8%) non-exposed (RR: 5, 95% CI: 1·7-14·6). Multivariate analysis showed that the number of transfusions increased the risk of iron overload (OR: 2·07, 95% CI: 1·36-2·14) while a higher one-minute Apgar score was associated with a lower risk (OR: 0·56, 95% CI: 0·32-0·99). Severe iron overload mainly occurred with a transfusion volume higher than 120 ml/kg. There was a positive correlation between ferritin and transfusion (r = 0·53; P < 0·001).
Conclusion:
There was a higher risk of iron overload in exposed infants in comparison with non-exposed infants. Severe iron overload in VLBW infants may occur with a total transfusion volume >120 ml/kg.
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