Crawford Tara M, Andersen Chad C, Hodyl Nicolette A, Robertson Sarah A, Stark Michael J
Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Department of Neonatal Medicine, Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia.
J Paediatr Child Health. 2019 Apr;55(4):387-392. doi: 10.1111/jpc.14402. Epub 2019 Feb 8.
Anaemia of prematurity will affect 90% of all very preterm infants, resulting in at least one red blood cell (RBC) transfusion. A significant proportion of preterm infants require multiple transfusions over the course of hospital admission. Growing evidence supports an association between transfusion exposure and adverse neonatal outcomes. In adults, transfusion-associated sepsis, transfusion-related acute lung injury and haemolytic reactions are the leading causes of transfusion-related morbidity and mortality; however, these are seldom recognised in newborns. The association between transfusion and adverse outcomes remains inconclusive. However, the evidence from preclinical studies demonstrates that RBC products can directly modulate immune cell function, a pathway termed transfusion-related immunomodulation (TRIM), which may provide a mechanism linking transfusion exposure with neonatal morbidities. Finally, we discuss the impact of TRIM on transfusion medicine, how we may address these issues and the emerging areas of research aimed at improving the safety of transfusions in this vulnerable population.
早产贫血将影响所有极早产儿中的90%，导致至少一次红细胞（RBC）输血。相当一部分早产儿在住院期间需要多次输血。越来越多的证据支持输血暴露与不良新生儿结局之间存在关联。在成年人中，输血相关脓毒症、输血相关急性肺损伤和溶血反应是输血相关发病和死亡的主要原因；然而，这些在新生儿中很少被认识到。输血与不良结局之间的关联仍无定论。然而，临床前研究的证据表明，红细胞制品可直接调节免疫细胞功能，这一途径称为输血相关免疫调节（TRIM），它可能提供一种将输血暴露与新生儿疾病联系起来的机制。最后，我们讨论了TRIM对输血医学的影响、我们如何解决这些问题以及旨在提高这一脆弱人群输血安全性的新兴研究领域。
