title: Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant.
abstract: BACKGROUND
  Transfusion of packed red blood cells (PRBCs) saves lives in the neonatal critical care setting and is one of the most common interventions in the preterm infant. The number and volume of PRBC transfusions are associated with several major neonatal morbidities, although a direct causal link between transfusion and major neonatal morbidity is still to be proven. Transfusion-related immunomodulation (TRIM) may underlie these adverse outcomes, yet it has received little attention in the high-risk preterm infant.
  
  
  METHODS
  One transfusion event was studied in infants ≤28 wk gestation between 2 and 6 wk postnatal age (n = 28). Plasma inflammatory cytokines and markers of endothelial activation were measured in the infants before and 2-4 h after transfusion, as well as in the donor pack.
  
  
  RESULTS
  Median (range) age at transfusion was 18 (14-39) days with the pretransfusion hemoglobin level at 9.8 (7.4-10.2) g/dl. Interleukin (IL)-1β (P = 0.01), IL-8 (P = <0.001), tumor necrosis factor-α (P = 0.008), and monocyte chemoattractant protein (P = 0.01) were increased after transfusion. A similar elevation in markers of endothelial activation was seen after transfusion with increased plasma macrophage inhibitory factor (P = 0.005) and soluble intracellular adhesion molecule-1 (P = <0.001).
  
  
  CONCLUSIONS
  Production of inflammatory cytokines and immunoactivation of the endothelium observed after the transfusion of PRBCs in the preterm infant may be a manifestation of TRIM. The implications of this emerging phenomenon within the preterm neonatal population warrant further investigation.
authors.affiliation: Department of Neonatal Medicine, Women's and Children's Hospital, South Australia, Australia.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Keir
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: McPhee
authors.forename: Chad C
authors.initials: CC
authors.lastname: Andersen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stark
mesh_terms: D015415:Biomarkers / Q000097:blood*; D016207:Cytokines / Q000097:blood*; D004727:Endothelium / Q000378:metabolism / Q000502:physiology*; D017707:Erythrocyte Transfusion; D053222:Fas Ligand Protein / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D053583:Interleukin-1beta / Q000097:blood; D008297:Male; D018945:Monocyte Chemoattractant Proteins / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D016207:Cytokines; D053222:Fas Ligand Protein; D006454:Hemoglobins; D053583:Interleukin-1beta; D018945:Monocyte Chemoattractant Proteins; D017395:Plasminogen Activator Inhibitor 1; D014409:Tumor Necrosis Factor-alpha