Treviño-Báez J D, Briones-Lara E, Alamillo-Velázquez J, Martínez-Moreno M I
High Specialty Medical Unit No. 23., Hospital of Obstetrics and Gynecology 'Dr. Ignacio Morones Prieto' of the Mexican Institute of Social Security, Monterrey, Nuevo Leon, Mexico.
Vox Sang. 2017 Jul;112(5):453-458. doi: 10.1111/vox.12528. Epub 2017 May 18.
To estimate the risk of iron overload in very low birthweight (VLBW) infants who receive more than two red blood cell (RBC) transfusions, in comparison with those who receive two or less during their hospital stay.
Prospective open cohort study in VLBW infants with >2 (exposed) and ≤2 (non-exposed) RBC transfusions. Ferritin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at birth and after each RBC transfusion. The incidence of iron overload was determined. Risk factors were analysed using a logistic regression model. RBC transfusion volume correlations with ferritin, ALT and AST were calculated with Spearman's rank correlation coefficient, as well as correlations between ferritin and aminotransferases.
A total of 63 patients were enrolled, 18 of which were exposed and 45 non-exposed. Twelve patients developed severe iron overload, eight exposed (44·5%) vs. four (8·8%) non-exposed (RR: 5, 95% CI: 1·7-14·6). Multivariate analysis showed that the number of transfusions increased the risk of iron overload (OR: 2·07, 95% CI: 1·36-2·14) while a higher one-minute Apgar score was associated with a lower risk (OR: 0·56, 95% CI: 0·32-0·99). Severe iron overload mainly occurred with a transfusion volume higher than 120 ml/kg. There was a positive correlation between ferritin and transfusion (r = 0·53; P < 0·001).
There was a higher risk of iron overload in exposed infants in comparison with non-exposed infants. Severe iron overload in VLBW infants may occur with a total transfusion volume >120 ml/kg.
比较住院期间接受超过两次红细胞（RBC）输血的极低出生体重（VLBW）婴儿与接受两次及以下输血的婴儿发生铁过载的风险。
对接受超过2次（暴露组）和≤2次（非暴露组）RBC输血的VLBW婴儿进行前瞻性开放队列研究。在出生时及每次RBC输血后测量铁蛋白、丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）。确定铁过载的发生率。使用逻辑回归模型分析危险因素。用Spearman等级相关系数计算RBC输血量与铁蛋白、ALT和AST之间的相关性，以及铁蛋白与转氨酶之间的相关性。
共纳入63例患者，其中18例为暴露组，45例为非暴露组。12例患者发生严重铁过载，8例暴露组（44.5%） vs. 4例非暴露组（8.8%）（相对危险度：5，95%可信区间：1.7 - 14.6）。多因素分析显示，输血次数增加铁过载风险（比值比：2.07，95%可信区间：1.36 - 2.14），而1分钟Apgar评分较高与较低风险相关（比值比：0.56，95%可信区间：0.32 - 0.99）。严重铁过载主要发生在输血量高于120 ml/kg时。铁蛋白与输血之间存在正相关（r = 0.53；P < 0.001）。
与非暴露婴儿相比，暴露婴儿发生铁过载的风险更高。VLBW婴儿总输血量>120 ml/kg时可能发生严重铁过载。
