Higher Level of RBC Transfusion may Not Have Efficacy for Anemia

Risk of anemia in preterm infants with low birth weight revealed no improvement even after transfusion of higher threshold of hemoglobin.

Risk of anemia is often high in infants with very low birth weight. To overcome this for survival, blood transfusions are performed. The levels of red blood cells (higher / lower) for the transfusion differ with subjective opinion of doctors.

However it is shown that using a higher level (threshold) of red blood cells (within clinically accepted limits) when ordering a transfusion, offers no advantage in survival or reduction in neurological impairment over a lower threshold, as per a National Institutes of Health-funded large, multi-centre randomized clinical trial study to-date on comparison of thresholds for blood transfusions in premature babies, published in The New England Journal of Medicine.

‘Risk of anemia in preterm infants with low birth weight revealed no improvement even after transfusion of higher threshold of hemoglobin. This portrays that the transfusion threshold of hemoglobin increased the number of transfusions, but did not improve the chance of survival without neuro developmental impairment, among the babies at two years of age.’

Preterm infants born before 29 weeks of pregnancy with weight less than 1,000 grams (slightly more than 2 pounds) are at high risk for anemia because of their early stage of development, reduced ability to produce red blood cells, and need for blood sampling as part of their intensive medical care.

RBCs threshold in anemia

Previous studies suggest that anaemic infants who received transfusions at a higher hemoglobin threshold within the currently accepted range would have a lower risk of death or developmental problems. Measuring hemoglobin, a protein produced in red blood cells, indicates the proportion of red blood cells. Hemoglobin transfusion thresholds for preterm infants vary according to weight, stage of maturity and other factors.

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845 infants were assigned to a higher hemoglobin threshold. Among them, 50.1% of them died or survived with neurodevelopmental impairment, as compared to 49.8% among 847 infants, who were assigned to a lower threshold.

When the two component outcomes were evaluated separately, the two groups also had similar rates of death (16.2% vs. 15%) and of neurodevelopmental impairment (39.6% vs 40.3%). It was observed that a higher hemoglobin threshold increased the number of transfusions, but did not improve the chance of survival without neuro developmental impairment, among the babies at two years of age.

"The findings are likely to be used to guide transfusion practice in the future for these infants; studies in premature infants are needed to guide care for these small and vulnerable infants; studies funded by NIH in multi-site networks are vitally important to the health of these fragile babies," says Dr. Rosemary Higgins, George Mason University's College of Health and Human Services, formerly the Project Scientist of the Neonatal Research Network.

Source-Medindia