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AS-1 red cells for neonatal transfusions: a randomized trial assessing donor exposure and safety
R G Strauss1, L F Burmeister, K Johnson
1Department of Pediatrics, University of Iowa College of Medicine, Iowa City, USA.
Insights
Using stored red blood cells (RBCs) from a single donor for premature infants significantly reduces donor exposure and is as safe as using fresh RBCs. This approach enhances transfusion safety for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Transfusion Medicine
- Pediatric Hematology
Background:
- Very-low-birth-weight infants often require multiple red blood cell (RBC) transfusions due to anemia of prematurity.
- Current practices frequently involve transfusing fresh RBCs, leading to exposure to multiple donors and potential risks of transfusion-transmitted infections.
- Erythropoietin therapy, while promising, does not eliminate the need for transfusions in severely ill premature infants.
Purpose of the Study:
- To evaluate the safety and efficacy of using RBCs stored in AS-1 media for up to 42 days for all transfusions in very-low-birth-weight infants.
- To compare the outcomes of infants receiving stored AS-1 RBCs with those receiving fresh RBCs stored in CPDA-1 media.
- To assess clinical and biochemical effects associated with AS-1 RBC transfusions in this population.
Main Methods:
- A randomized, single-blind clinical trial involving very-low-birth-weight infants (0.6-1.3 kg) during the first 84 days of life.
- Primary endpoint: assessing if AS-1 stored RBCs (≤42 days) could meet all transfusion needs (15 mL/kg/dose).
- Control group received fresh RBCs (≤7 days) in CPDA-1 storage media; both groups received standard nursery care.
Main Results:
- Infants receiving AS-1 RBCs were exposed to a mean of 1.6 donors, significantly lower than the 3.7 donors for infants receiving CPDA-1 RBCs (p < 0.05).
- No significant differences were observed in clinical transfusion reactions between the two groups.
- Multiple laboratory tests showed no significant adverse effects in infants transfused with AS-1 RBCs stored for ≤42 days compared to fresh CPDA-1 RBCs.
Conclusions:
- Stored AS-1 RBCs, typically from a single dedicated donor, can safely meet the transfusion requirements for most very-low-birth-weight infants.
- This transfusion strategy significantly reduces exposure to multiple donors.
- Utilizing AS-1 stored RBCs is likely to enhance transfusion safety in premature infants.
Background:
Despite recent optimism about the use of erythropoietin therapy to treat the anemia of prematurity, very-low-birth-weight infants who are severely ill receive multiple red cell (RBC) transfusions. Many physicians transfuse relatively fresh RBCs to newborn infants, exposing them to multiple donors and possibly increasing their risk of acquiring transfusion-transmitted infections.
Study Design And Methods:
A randomized, single-blind clinical trial was conducted to determine, as the primary endpoint, whether RBCs collected from one dedicated donor and stored for < or = 42 days in AS-1 storage media could safely supply all small-volume RBC transfusions (15 mL/kg/dose) needed by very-low-birth-weight infants (0.6-1.3 kg) during the first 84 days of life. Secondary endpoints were the assessment of the possible adverse clinical and biochemical effects of transfusing AS-1 RBCs stored for < or = 42 days. Control infants received identical nursery care, except they received fresh RBCs stored < or = 7 days in CPDA-1.
Results:
Infants transfused with AS-1 RBCs were exposed to a mean of 1.6 donors,-compared with an exposure to 3.7 donors for infants given CPDA-1 RBCs (p < 0.05). Neither clinical transfusion reactions nor the results of multiple laboratory tests were significantly different in infants who received slow transfusions (15 mL/kg) of AS-1 RBCs stored for < or = 42 days and in infants who received the same volume of CPDA-1 RBCs stored < or = 7 days.
Conclusion:
AS-1 RBCs, usually from only one dedicated donor, can safely supply all RBCs needed by most very-low-birth-weight infants-a practice that decreases donor exposure and likely increases transfusion safety.