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World J Clin Pediatr. Aug 8, 2014; 3(3): 19-29
Published online Aug 8, 2014. doi: 10.5409/wjcp.v3.i3.19
Transfusion related morbidity in premature babies: Possible mechanisms and implications for practice
Keith James Collard
Keith James Collard, Peninsula Allied Health Centre, School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, PL6 8BH, United Kingdom
Author contributions: Collard KJ solely contributed to this paper.
Supported by The Northcott Devon Medical Foundation; The NHS SW Research; and Development Fund
Correspondence to: Keith Collard, PhD, Associate Professor, Peninsula Allied Health Centre, School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, United Kingdom. keith.collard@plymouth.ac.uk
Telephone: +44-1752-587585 Fax: +44-1752-588874
Received: November 27, 2013
Revised: March 19, 2014
Accepted: May 31, 2014
Published online: August 8, 2014
Abstract

Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have little reserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.

Keywords: Blood transfusions, Premature babies, Iron, Heme, Oxidative stress, Storage lesion, Complications of prematurity

Core tip: Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. Studies have shown correlations between the receipt of blood transfusions and the development of the major complications of prematurity. Little is known of the underlying pathophysiology of this relationship. This review examines novel potential mechanisms which are related to the changes that occur in iron, heme and oxidative status in paediatric packed cell units during preparation and storage, and in the ability of the premature baby to deal with these changes following receipt of blood transfusion.