Prematürede anemi ve transfüzyon politikaları

Year 2022, , 407 - 424, 01.04.2022

Özmert M.a. Özdemir

https://doi.org/10.31362/patd.1031857

Abstract

Yenidoğan döneminde anemi, fizyolojik olabildiği gibi prenatal, perinatal ve postnatal pek çok neden sonucu gelişebilmekte, ancak özellikle aşırı prematüre bebeklerde en önemli anemi nedenlerinden birisini iyatrojenik kan kayıpları oluşturmaktadır. Anemi saptanan bir yenidoğanda eritrosit transfüzyon kararı doku oksijenizasyonunu optimize edecek kan hemoglobin veya hematokrit düzeylerinin devamlılığının sağlanması amacıyla verilmektedir. Bunun için ise pratikte bebeğin kan hemoglobin ve/veya hematokrit düzeyi ve klinik durumu önem kazanmaktadır. Eritrosit transfüzyonunun pek çok potansiyel komplikasyonu da düşünüldüğünde prematüre bebeklere eritrosit transfüzyonu kararı verilirken kar-zarar oranı gözetilerek, güncel uygulamalar ışığında klinik bulguları eşliğinde bireyselleştirilmiş transfüzyon kararı verilmesi uygun gözükmektedir, ancak asıl amaç prematüre bebeklerde anemi gelişiminin önlenmesi olmalıdır.
Bu derlemede prematüre anemisi, tanısı, transfüzyon tedavisi, komplikasyon ve korunma stratejileri son güncel uygulamalar ışığında verilmeye çalışılmıştır.

Keywords

Prematüre bebek, anemi, transfüzyon

Anemia and transfusion policies in premature infants

Abstract

In the neonatal period, anemia may be physiological as well as many prenatal, perinatal and postnatal causes; however, especially in some extremely premature infants, one of the most important causes of anemia is iatrogenic blood losses. The decision of red blood cells transfusion in a newborn with anemia is made in order to maintain blood hemoglobin or hematocrit levels which will optimize tissue oxygenation. For that, the baby's blood hemoglobin and/or hematocrit level and clinical status are important practically. Considering the many potential complications of red blood cells transfusion, it seems appropriate to make an individualized transfusion decision in the light of current practices and clinical findings while deciding on transfuison of red blood cells for premature infants, however the main goal should be to prevent the development of anemia in premature infants.
In this review, anemia of prematurity, diagnosis, transfusion therapy, complications and prevention strategies have been tried to be given in the light of recent current practices.

Keywords

Preterm infant, anemia, transfusion

References

• 1. Letterio J, Poteva I, Petrosiute A, Ahuja S. Hematologic and oncologic problems in the fetüs and neonate. In: Martin R, Fanaroff AA, Walsh MC, eds. Fanaroff & Martin’s neonatal-perinatal medicine, diseases of the fetus and infant. 11th ed. Philadelphia: Elsevier, 2020;1416-1475.
• 2. Gomella TL, Eyal FG, Bany-Mohammed F. Gomella’s Neonatology management, procedures, on-call problems, diseases, and drugs. 8th ed. New York: Mc Graw Hill, 2020;815-822.
• 3. Akpan U, Orth E, Moore R, et al. The hematopoietic system. In: Jnah AJ, Trembath AN, eds. Fetal and neonatal physiology for the advanced practice nurse. New York: Springer Publishing Company, 2019;381-454.
• 4. Lopriore E. Updates in red blood cell and platelet transfusions in preterm neonates. Am J Perinatol 2019;36(Suppl S2):S37-S40. https://dx.doi.org/ 10.1055/s-0039-1691775.
• 5. Christensen RD. Neonatal ertythrocyte disorders. In: Gleason CA, Juul SE, eds. Avery’s diseases of the newborn. 10th ed. Philadelphia: Elsevier, 2018;1152-1179.
• 6. Zerra PE, Josephson CD. Transfusion in neonatal patients: review of evidence-based guidelines. Clin Lab Med 2021;41:15-34. https://dx.doi.org/10.1016/j.cll.2020.10.002.
• 7. Steiner L. Erythrocyte. In: Chess PA, ed. Avery’s neonatology board review. 1st ed. 2019;288-295.
• 8. Cibulskis CC, Maheshwari A, Rao R, Mathur AM. Anemia of prematurity: how low is too low? J Perinatol 2021;41(6):1244-1257. https://dx.doi.org/ 10.1038/s41372-021-00992-0.
• 9. Christensen RD, Henry E. Reference intervals in neonatal hematology. Clin Perinatol 2015;42:483-497. https://dx.doi.org/10.1016/j.clp.2015.04.005.
• 10. Saito-Benz M, Flanagan P, Berry MJ. Management of anaemia in pre-term infants. Br J Haematol 2020;188(3):354–366. https://dx.doi.org/10.1111/bjh.16233.
• 11. Del Vecchio A, Franco C, Petrillo F, D’Amato G. Neonatal transfusion practice: when do neonates need red blood cells or platelets? Am J Perinatol 2016;33:1079-1084. https://dx.doi.org/10.1055/s-0036-1586106.
• 12. Howarth C, Banerjee J, Aladangady N. Red blood cell transfusion in preterm infants: current evidence and controversies. Neonatology 2018;114:7-16. https://dx.doi.org/10.1159/000486584.
• 13. Kalteren WS, Verhagen EA, Mintzer JP, Bos AF, Kooi EMW. Anemia and red blood cell transfusions, cerebral oxygenation, brain injury and development, and neurodvelomental outcpme in preterm infants: a systemic review. Front Pediatr 2021;9:644462. https://dx.doi.org/10.3389/fped.2021.644462.
• 14. Dror Y, Chan AKC, Baker JM, Avila ML. Hematology. In: MacDonald MG, Seshia MMK, eds. Avery’s neonatology pathophysiology & management of the newborn. 7th ed. Philadelphia: Wolters Kluwer, 2016;872-929.
• 15. Lanzkowsky P. Anemia during the neonatal period. In: Lanzkowsky P, Lipton JM, Fish JD, eds. Lanzkowsky’s manual of pediatric hematology and oncology. 6th ed. Amsterdam: Elsevier, 2016;51-68.
• 16. Perk Y. Atasay B, Çetinkaya M. Türk Neonatoloji Derneği Kan Ürünleri Transfüzyon Rehberi 2021 Güncellemesi.
• 17. Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update. Neonatology 2019;115:432–450. https://dx.doi.org/10.1159/000499361.
• 18. Jacquot C, Mo YD, Luban NLC. Blood component therapy for the neonate. In: Martin R, Fanaroff AA, Walsh MC, eds. Fanaroff & Martin’s neonatal-perinatal medicine, diseases of the fetus and infant. 11th ed. Philadelphia: Elsevier, 2020;1476-1503.
• 19. Villeneuve A, Arsenault V, Lacroix J, Tucci M. Neonatal red blood cell transfusion. Vox Sang 2021;116:366-378.https://dx.doi.org/10.1111/vox.13036.
• 20. Shah A, Brunskill SJ, Desborough MJ, Doree C, Trivella M, Stanworth SJ. Transfusion of red blood cells stored for shorter versus longer duration for all conditions. Cochrane Database Syst Rev 2018;12(12):CD010801. https://dx.doi.org/10.1002/14651858.CD010801.pub3.
• 21. Fergusson DA, Hebert P, Hogan DL, LeBel L, Rovinez-Bouali N, Smyth JA. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. JAMA 2012;308(14):1443-1451. https://dx.doi.org/10.1001/2012.jama.11953.
• 22. Kirpalani H, Whyte RK. What is new about transfusions for preterm infants? An uptodate. Neonatology 2019;115:406-410. https://dx.doi.org/10.1159/000499048.
• 23. Franz AR, Engel C, Bassler D, et al. Effects of Liberal vs Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants The ETTNO Randomized Clinical Trial. JAMA 2020;324(6):560-570. https://dx.doi.org/10.1001/jama.2020.10690.
• 24. Kirpalani H, Bell EF, Johnson KJ, et al. A randomized trial of higher versus lower hemoglobin transfusion threshold for extremely low birth weight (ELBW) infants: The Transfusion of Prematures (TOP) Trial. 2020. Available at:https://plan.core-apps.com/pas2020/abstract/6edec56c63f592adb37f205ea944d7d8.
• 25. Bell EF, Strauss RG, Widness JA, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 2005; 115(6):1685–1691. https://dx.doi.org/10.1542/peds.2004-1884.
• 26. Kirpalani H, Whyte RK, Andersen C, et al. The Prematur Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion treshold for extremely low birth weight infants. J Pediatr 2006;149:301-307. https://dx.doi.org/10.1016/j.jpeds.2006.05.011.
• 27. Whyte RK, Kirpalani H, Asztalos EV, et al., the PINTOS Study Group study. Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics 2009;123:207–213. https://dx.doi.org/10.1542/peds.2008-0338.
• 28. Chen HL, Tseng HI, Lu CC, Yang SN, Fan HC, Yang RC. Effect of blood transfusions on the outcome of very low body weight preterm infants under two different transfusion criteria. Pediatr Neonatol 2009;50(3):110−116. https://dx.doi.org/10.1016/S1875-9572(09)60045-0. 29. Wang P, Wang X, Deng H, et al. Restrictive versus liberal transfusion threshold in very low birth weight infants: A systematic review with meta-analysis. PLoS One 2021:16(8);e0256810. https://dx.doi.org/10.1371/journal.pone.0256810.
• 30. Persad E, Sibrecht G, Ringsten M, et al. Interventions to minimize blood loss in very preterm infants—A systematic review and meta-analysis. PLoS One 2021;16(2):e0246353. https://dx.doi.org/10.1371/journal.pone.0246353.
• 31. Puia-Dumitrescu M, Tanaka DT, Spears TG, et al. Patterns of phlebotomy blood loss and transfusions in extremely low birth weight infants. J Perinatol 2019;39(12):1670-1675. https://dx.doi.org/10.1038/s41372-019-0515-6.
• 32. Brener PH, Galletti MF, Carrascal MP, et al. Impact of the volume of blood collected by phlebotomy on transfusion requirements in preterm infants with birth weight of less than 1500 g. A quasi-experimental study. Arch Argent Pediatr 2020;118(2):109-116. https://dx.doi.org/10.5546/aap.2020.eng.109.
• 33. Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 2018;218(1):1-18. https://dx.doi.org/10.1016/j.ajog.2017.10.231.
• 34. Rabe H, Gyte GMI, Diaz-Rossello JL, Duley L. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2019;9(9):CD003248. https://dx.doi.org/10.1002/14651858.CD003248.pub4.
• 35. Zhao Y, Hou R, Zhu X, Ren L, Lu H. Effects of delayed cord clamping on infants after neonatal period: a systematic review and meta-analysis. Int J Nurs Stud 2019;92:97-108. https://dx.doi.org/10.1016/j.ijnurstu.2019.01.012.
• 36. Ortiz-Esquina I, Gomez-Salgado J, Rodriguez-Almagro J, Arias-Arias A, Ballesta-Castillejos A, Hernandez-Martinez A. Umbilical cord milking in infants born at <37 weeks of gestation: a systematic review and meta-analysis. J Clin Med 2020;9(4):1071. https://dx.doi.org/10.3390/jcm9041071.
• 37. Seidler AL, Gyte GML, Rabe H, et al. Umbilical cord management for newborns <34 weeks' gestation: a meta-analysis. Pediatrics 2021;147(3):e20200576. https://dx.doi.org/10.1542/peds.2020-0576.
• 38. Gomersall J, Berber S, Middleton P, et al. Umbilical cord management at term and late preterm birth: a meta-analysis. Pediatric 2021;147(3):e2020015404. https://dx.doi.org/10.1542/peds.2020-015404.
• 39. Jasani B, Torgalkar R, Ye XY, Syed S, Shah PS. Association of umbilical cord management strategies with outcomes of preterm infants: a systematic review and network meta-analysis. JAMA Pediatr 2021;175(4):e210102. https://dx.doi.org/10.1001/jamapediatrics.2021.0102.
• 40. Katheria A, Reister F, Essers J, et al. Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants. JAMA 2019;322(19):1877-1886. https://dx.doi.org/10.1001/jama.2019.16004.
• 41. Oygür N, Önal E, Zenciroğlu A. Türk Neonatoloji Derneği Doğum Salonu Yönetim Rehberi 2021 Güncellemesi.
• 42. Aher SM, Ohlsson A. Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants (Review). Cochrane Database Syst Rev 2020;2(2):CD004865. https://dx.doi.org/10.1002/14651858.
• 43. Ohlsson A, Aher SM. Early erythropoiesis-stimulating agents in preterm or low birth weight infants (Review). Cochrane Database Syst Rev 2020;2(2):CD004863. https://dx.doi.org/10.1002/14651858.
• 44. Patel RM, Knezevic A, Yang J, Shenvi N, Hinkes M, Roback JD. Enteral iron supplementation, red blood cell transfusion, and risk of bronchopulmonary dysplasia in very-low-birth-weight infants. Transfusion 2019;59(5):1675-1682. https://dx.doi.org/10.1111/trf.15216.
• 45. Mills RJ, Davies MW. Enteral iron suplementation in preterm and low birth weight infants (review). Cochrane Database Syst Rev 2012. CD005095. https://dx.doi.org/10.1002/14651858.
• 46. McCarthy EK, Dempsey EM, Kiely ME. Iron suplementation in preterm and low-birth-weight-infants: a systematic review of intervention studies. Nutr Rev 2019;77(12):865-877. https://dx.doi.org/10.1093/nutrit/nuz051.
• 47. Kültürsay N, Bilgen H, Türkyılmaz C. Türk Neonatoloji Derneği Prematüre ve Hasta Term Bebeğin Beslenmesi Rehberi 2018 Güncellemesi.
• 48. Crawford TM, Andersen CC, Hodly NA, Robertson SA, Stark MJ. The contribution of red blood cell transfuison to neonatal morbidity and mortality. J Paediatr Child Health 2019;55(4):387-392. https://dx.doi.org/10.1111/jpc.14402.
• 49. Keir A, Sanchita P, Trivella M, et al. Adverse effects of red blood cell transfusions in neonates: a systematic review and meta-analysis. Transfusion 2016;56(11):2773-2780. https://dx.doi.org/10.1111/trf.13785.
• 50. Lee EY, Kim SS, Park GY,Lee SH. Effect of red blood cell transfusion on short-term outcomes in very low birth weight infants. Clin Exp Pediatr 2020;63(2):56-62. https://dx.doi.org/10.3345/kjp.2019.00990.
• 51. D’Amato G, Faienza MF, Palladino V, et al. Red blood cell transfusions and potentially related morbidities in neonates under 32 weeks' gestation. Blood Transfus 2021;19(2):113-119. https://dx.doi.org/10.2450/2020.0092-20.
• 52. Çizmeci MN, Akın MA, Özek E. Türk Neonatoloji Derneği Germinal Matriks Kanaması-İntraventriküler Kanama ve Komplikasyonalrının Tanı ve Yönetim Rehberi 2021.
• 53. Bas AY, Demirel N, Koc E, Isik DU, Hirfanoğlu İM, Tunc T, TR-ROP Study Group. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol 2018;102(12):1711-1716. https://dx.doi.org/10.1136/bjophthalmol-2017-311789.
• 54. Zhu Z, Hua X, Yu Y, Zhu P, Hong K, Ke Y. Effect of red blood cell transfusion on the development of retinopathy of prematurity: A systematic review and meta-analysis. PLoS One 2020;15(6):e0234266. https://dx.doi.org/10.1371/journal.pone.0234266.
• 55. Koç E, Baş AY, Özdek Ş, Ovalı F. Türk Neonatoloji Derneği-Türk Oftalmoloji Derneği Türkiye Prematüre Retinopatisi Rehberi 2021 Güncellemesi.
• 56. Patel RM, Knezevic A, Shenvi N, et al. Association of red blood cell transfusion, anemia, and necrotising enterocolitis in very low birth weight infants. JAMA 2016;315(9):889-897. https://dx.doi.org/10.1001/jama.2016.1204.
• 57. Garg P, Pinotti R, Lal CV, Salas AA. Transfusion-associated necrotizing enterocolitis in preterm infants: an updated meta-analysis of observational data. J Perinat Med 2018;46(6):677-685. https://dx.doi.org/10.1515/jpm-2017-0162.
• 58. Yeo KT, Kong JY, Sasi A, Tan K, Lai NM, Schindler T. Stopping enteral feeds for prevention of transfusion-associated necrotising enterocolitis in preterm infants. Cochrane Database Syst Rev 2019(10):CD012888. https://dx.doi.org/10.1002/14651858.
• 59. Ergenekon E, Tayman C, Özkan H. Türk Neonataolji Derneği Nekrotizan Enterekolit Tanı, Tedavi ve Korunma Rehberi 2021.
• 60. Use of blood components in newborn. Avaialble at: https://www.nnfi.org/assests/pdf/cpg-guidelines/Blood%20%20components--Key%20Recommendations.pdf. Erişim tarihi 2 Aralık 2021.
• 61. Benavidesa A, Conrad AL, Brumbaugh JE, Magnotta V, Bell EF, Nopoulos P. Long-term outcome of brain structure in female preterm infants: possible associations of liberal versus restrictive red blood cell transfusions. J Matern Fetal Neonatal Med 2021;34(20):3292-3299. https://dx.doi.org/10.1080/14767058.2019.1683157.
• 62. Kalteren WS, Verhagen EA, Mintzer JP, Bos AF, Kooi EMW. Anemia and red blood cell transfusions, cerebral oxygenation, brain injury and development, and neurodevelopmental outcome in preterm infants: a systematic review. Front Pediatr 2021;9:644462. https://dx.doi.org/10.3389/fped.2021.644462.
• 63. Fontana C, Raffaeli G, Pesenti N, et al. Red blood cell transfusions in preterm newborns and neurodevelopmental outcomes at 2 and 5 years of age. Blood Transfus 2020 Dec 1. https://dx.doi.org/doi: 10.2450/2020.0207-20. [Epub ahead of print]
• 64. Lum TG, Sugar J, Yim R, et al. Two-year neurodevelopmental outcomes of preterm infants who received red blood cell transfusion. Blood Transfus 2021. https://dx.doi.org/10.2450/2021.0070-21. [Epub ahead of print]
• 65. Vu PT, Ohls RK, Mayock DE, et al., and for the PENUT Consortium. Transfusions and neurodevelopmental outcomes in extremely low gestation neonates enrolled in the PENUT Trial: a randomized clinical trial. Pediatr Res 2021;90(1):109-116. https://dx.doi.org/10.1038/s41390-020-01273-w.
• 66. Goodnough LT, Panigrahi AK. Blood transfusion therapy. Med Clin N Am 2017;101(2):431-447. https://dx.doi.org/10.1016/j.mcna.2016.09.012.