title: A mathematical modeling approach to quantify the role of phlebotomy losses and need for transfusions in neonatal anemia.
abstract: BACKGROUND
  Very preterm infants commonly develop anemia requiring multiple red blood cell transfusions (RBCTx). This is in part attributable to heavy laboratory phlebotomy loss. Quantification of the extent to which laboratory blood loss contributes to anemia sufficient to prompt RBCTx has not been examined.
  
  
  METHODS
  Twenty-six preterm infants weighing less than 1500 g at birth requiring ventilator support who received one or more RBCTx were intensively studied during the first month of life. Hemoglobin (Hb) loss via laboratory blood loss and RBC senescence and Hb gain from RBCTx were precisely accounted for in a Hb mass balance mathematical model developed to assess the impact of phlebotomy on RBCTx when restrictive RBCTx criteria were applied.
  
  
  RESULTS
  Study subjects had a birth weight of 880 ± 240 g (mean ± SD) and a Hb level of 14.4 ± 2.4 g/dL at birth and received 3.81 ± 2.15 RBCTx during the study period. Modeling indicated that even with the total elimination of laboratory phlebotomy loss, a reduction of 41% to 48% in RBCTx was achievable.
  
  
  CONCLUSIONS
  The present modeling results indicate that while phlebotomy reduction can significantly decrease the number of RBCTx administered to preterm infants, total elimination of all RBCTx will likely require other approaches, for example, stimulation of erythropoiesis with erythropoiesis-stimulating agents.
authors.affiliation: College of Pharmacy and College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosebraugh
authors.forename: John A
authors.initials: JA
authors.lastname: Widness
authors.forename: Demet
authors.initials: D
authors.lastname: Nalbant
authors.forename: Peter
authors.initials: P
authors.lastname: Veng-Pedersen
mesh_terms: D000751:Anemia, Neonatal / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy*; D001724:Birth Weight; D001803:Blood Transfusion; D001810:Blood Volume / Q000502:physiology; D001811:Blood Volume Determination / Q000379:methods; D003198:Computer Simulation; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D019102:Infant, Very Low Birth Weight / Q000097:blood; D008297:Male; D008955:Models, Cardiovascular; D018962:Phlebotomy / Q000009:adverse effects*; D011247:Pregnancy
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin