Effect of frequent blood transfusions on steroid determinations in newborn infants

The birth of an infant with ambiguous genitalia constitutes a medical emergency. Ill infants with ambiguous genitalia often require blood transfusions. We studied steroid levels in packed red blood cells from 10 healthy adult donors to determine whether packed red blood cells contain significant amounts of donor steroids that might interfere with hormonal testing. Levels of cortisol, 17-hydroxypregnenolone, 17-hydroxyprogesterone, aldosterone, and dihydrotestosterone were well below normal newborn values. Hemolyzed packed red blood cells were used to provide the maximum possible donor steroid contribution. The concentration of testosterone was substantial in hemolyzed packed red blood cells but was effectively reduced to below normal female newborn levels by washing packed red blood cells by a standard blood bank procedure. Corticotropin testing for evaluation of adrenal function can be done accurately, even in infants receiving frequent transfusions of packed red blood cells. To avoid any misinterpretation of testosterone levels, it might be prudent to use washed packed red blood cells during human chorionic gonadotropin testing to evaluate Leydig cell function.