title: Vascular endothelial growth factor as marker for tissue hypoxia and transfusion need in anemic infants: a prospective clinical study.
abstract: OBJECTIVE
  Oxygen-carrying capacity of blood is reduced in anemic infants because of low hemoglobin levels. Red blood cell transfusions become necessary if low hematocrit causes tissue hypoxia. No reliable parameters exist for detecting chronic tissue hypoxia. Vascular endothelial growth factor is upregulated by hypoxia; hence, elevated vascular endothelial growth factor levels may be a marker for tissue hypoxia and may indicate the need for red blood cell transfusions.
  
  
  METHODS
  In a prospective study, plasma vascular endothelial growth factor levels were measured in 3 groups of infants suspected of requiring red blood cell transfusions to find a vascular endothelial growth factor cutoff value indicative of tissue hypoxia. The 3 groups were acute anemic (an episode of acute bleeding [hematocrit drop > 5%] per day); chronic anemic (hematocrit drop < 5% per day); and nontransfused (hematocrit drop < 5% per day) but not meeting clinical criteria for a transfusion. Blood was sampled before transfusion and again 48 hours after transfusion if required. Plasma vascular endothelial growth factor and erythropoietin concentrations were measured.
  
  
  RESULTS
  Vascular endothelial growth factor concentrations were lower in acutely anemic compared with chronically anemic infants, whereas erythropoietin levels did not differ between these groups. The vascular endothelial growth factor concentration was <140 pg/mL in all acutely anemic infants, and this was deemed the threshold level indicating sufficient tissue oxygenation in subsequent analysis. We found that 30% of chronically anemic and 43% of nontransfused infants had vascular endothelial growth factor levels of >140 pg/mL. In transfused infants, with elevated vascular endothelial growth factor levels, red blood cell transfusion resulted in lowering of vascular endothelial growth factor concentrations.
  
  
  CONCLUSIONS
  Vascular endothelial growth factor concentrations of >140 pg/mL may indicate insufficient oxygen delivery to tissues and may serve as a marker of the need for transfusion or of tissue hypoxia in other diseases.
authors.affiliation: University Hospital Carl Gustav Carus Dresden, Department of Neonatology and Pediatric Intensive Care, Pediatrics, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Edda
authors.initials: E
authors.lastname: Tschirch
authors.forename: Benedikt
authors.initials: B
authors.lastname: Weber
authors.forename: Petra
authors.initials: P
authors.lastname: Koehne
authors.forename: Florian
authors.initials: F
authors.lastname: Guthmann
authors.forename: Alexander
authors.initials: A
authors.lastname: von Gise
authors.forename: Roland R
authors.initials: RR
authors.lastname: Wauer
authors.forename: Mario
authors.initials: M
authors.lastname: Rüdiger
mesh_terms: D000751:Anemia, Neonatal / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006400:Hematocrit; D006470:Hemorrhage / Q000097:blood / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: D015415:Biomarkers; D042461:Vascular Endothelial Growth Factor A; D004921:Erythropoietin