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The contribution of red blood cell transfusion to neonatal morbidity and mortality

Tara M Crawford1, Chad C Andersen1,2, Nicolette A Hodyl1

  • 1Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.

Journal of Paediatrics and Child Health
|February 10, 2019
PubMed

Insights

Very preterm infants often need red blood cell (RBC) transfusions due to anemia. Transfusion-related immunomodulation (TRIM) may link RBC transfusions to adverse outcomes in newborns, necessitating safer transfusion strategies.

Area of Science:

  • Neonatal Medicine
  • Transfusion Medicine
  • Immunology

Background:

  • Anemia of prematurity affects 90% of very preterm infants, often requiring red blood cell (RBC) transfusions.
  • Multiple transfusions are common in preterm infants, raising concerns about transfusion-associated risks.
  • While severe transfusion reactions are rare in newborns, the link between transfusions and adverse outcomes needs further investigation.

Purpose of the Study:

  • To explore the potential mechanisms linking RBC transfusions to adverse neonatal outcomes.
  • To discuss the role of transfusion-related immunomodulation (TRIM) in neonatal transfusion medicine.
  • To identify emerging research areas for improving transfusion safety in preterm infants.

Main Methods:

  • Review of preclinical studies demonstrating RBCs' immunomodulatory effects.
  • Analysis of existing literature on transfusion-associated morbidities in neonates.
  • Discussion of current transfusion practices and future research directions.

Main Results:

  • Preclinical evidence suggests RBCs can modulate immune cell function, a process termed TRIM.
  • TRIM offers a potential pathway explaining the association between RBC transfusions and neonatal morbidities.
  • Established transfusion reactions in adults are seldom recognized in newborns, highlighting a knowledge gap.

Conclusions:

  • TRIM is a critical pathway to consider in neonatal transfusion medicine.
  • Addressing TRIM requires innovative strategies to mitigate risks associated with RBC transfusions in preterm infants.
  • Further research is essential to enhance the safety and efficacy of transfusions for vulnerable neonatal populations.

Keywords:
morbiditymortalitypretermred blood cell transfusiontransfusion-related immunomodulation

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