Bilirubin levels and phototherapy use before and after neonatal red blood cell transfusions.
Our previous retrospective study suggested that red blood cell (RBC) transfusion of preterm neonates can be associated with an increase in bilirubin, but this has not been tested prospectively.



We studied neonates before and after RBC transfusions, recording serial bilirubin levels and whether they qualified for phototherapy. Because lysed RBCs release plasma-free hemoglobin (Hb), a precursor to bilirubin, we also measured plasma free Hb and bilirubin from the donor blood.



We studied 50 transfusions given to 39 neonates. Gestation ages of transfused neonates, at birth, were 26 (24-29) weeks (median [interquartile range]); birthweights were 750 (620-1070) g. The study transfusion was given on Day of Life 9.9 (3.4-19.2). In 20% (10/50) phototherapy was being administered at the beginning of and during the transfusion. In these patients neither the 4- to 6- nor the 24- to 36-hour-posttransfusion bilirubin levels were significantly higher than before transfusion. However, in 30% of the others (12/40) phototherapy was started (or restarted) after the transfusion and 15% had a posttransfusion bilirubin increase of at least 2.5 mg/dL. These neonates received donor blood with a higher plasma-free Hb (p < 0.05).



Neonates commonly qualify for phototherapy after transfusion. A minority (15% in this series) have a posttransfusion bilirubin increase of at least 2.5 mg/dL. We speculate that neonates qualifying for a RBC transfusion, who are judged to be at high risk for bilirubin-induced neurotoxicity, might benefit from checking their serum bilirubin level after the transfusion and providing donor blood with low plasma-free Hb levels.
Women and Newborns Program, Dixie Regional Medical Center, St George, Utah.|Neonatology, Dixie Regional Medical Center, St George, Utah.
Patrick D
PD
Carroll
Women and Newborns Program, Dixie Regional Medical Center, St George, Utah.|Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Robert D
RD
Christensen
Women and Newborns Program, Dixie Regional Medical Center, St George, Utah.|Neonatology, McKay Dee Hospital Center, Ogden, Utah.
Vickie L
VL
Baer
Women and Newborns Program, Dixie Regional Medical Center, St George, Utah.|Neonatology, McKay Dee Hospital Center, Ogden, Utah.
Mark J
MJ
Sheffield
Women and Newborns Program, Dixie Regional Medical Center, St George, Utah.|Neonatology, Utah Valley Regional Medical Center, Provo, Utah.
Erick
E
Gerday
Women and Newborns Program, Dixie Regional Medical Center, St George, Utah.|Transfusion Medicine Services, Intermountain Healthcare, Salt Lake City, Utah.
Sarah J
SJ
Ilstrup
D001663:Bilirubin / Q000097:blood*; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010789:Phototherapy / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies
D006454:Hemoglobins; D001663:Bilirubin