Effects of red blood cell transfusions during the first week of life on acid-base, glucose, and electrolytes in preterm neonates.
BACKGROUND
More than 90 percent of extremely low-birth-weight infants receive one or more transfusions of red blood cells (RBCs). The objective was to assess if RBC transfusions may induce significant changes of plasma acid-base, electrolyte, and glucose status in extremely preterm infants.


METHODS
Records of infants with gestational age of less than 31 weeks who were transfused with RBCs during the first week of life were reviewed (n = 61). Blood samples were collected from infants before and after transfusions to evaluate hemoglobin (Hb) level, hematocrit, acid-base, electrolyte, and glucose status. Then infants were stratified into four groups that received a RBC volume of less than 15, 15 to 20, more than 20 to 25, or more than 25 mL per kg.


RESULTS
Infants received 20.7 (+/-1.5) mL per kg RBCs. After transfusions, a significant increase of pO(2) (p < 0.0001) and decrease of Ca(2+) (p = 0.047) and glycemia (p < 0.0001) were observed. Infants who were transfused with more than 25 mL per kg were significantly less immature, heavier, and more anemic than infants in other groups. A positive relationship was found between changes of patients' potassium plasma level and K(+) intake through RBC transfusion (r = 0.442, p = 0.008). Three (4.9%) infants developed hyperkalemia, one (1.6%) had an exacerbation of his hypocalcemia, and another (1.6%) of his hypoglycemia.


CONCLUSIONS
RBC transfusions were effective in correcting anemia in our patients and induced a slight increase of pH and pO(2) and decrease of Ca(2+) and glycemia, which were not clinically relevant. A linear direct correlation was observed between potassium intake by RBC transfusions and changes of kalemia in our infants, but there was not an increase of K(+) plasma level after transfusions.
Dani
Carlo
C
Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Florence, Italy. cdani@unifi.it
Perugi
Silvia
S
Benuzzi
Alessandra
A
Corsini
Iuri
I
Bertini
Giovanna
G
Pratesi
Simone
S
Rubaltelli
Firmino F
FF
D000136:Acid-Base Equilibrium; D000740:Anemia / Q000097:blood / Q000628:therapy*; D001786:Blood Glucose / Q000032:analysis*; D004573:Electrolytes / Q000097:blood*; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology; D006996:Hypocalcemia / Q000209:etiology; D007003:Hypoglycemia / Q000209:etiology; D000860:Hypoxia / Q000097:blood / Q000628:therapy; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood / Q000628:therapy; D007234:Infant, Premature / Q000097:blood*; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D008297:Male; D012189:Retrospective Studies
D001786:Blood Glucose; D004573:Electrolytes