University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA.
University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA; University of Michigan, Fetal Diagnosis and Treatment Center, Ann Arbor, MI, USA.
J Pediatr Surg. 2021 Nov;56(11):1944-1948. doi: 10.1016/j.jpedsurg.2021.04.018. Epub 2021 Apr 24.
The aim of this study was to assess the percent decrease in fetal hemoglobin (HbF) after transfusion of adult-derived donor packed red blood cell (pRBC) units in extremely low gestational age newborns (ELGANs).
Control percent fetal hemoglobin (%HbF) levels were measured in newborn cord blood or peripheral blood samples in non-transfused patients prior to elective surgery. ELGANs were followed prospectively and %HbF was measured on residual post-test complete blood count (CBC) specimens. ELGAN %HbF values were compared to the control population and transfusions were recorded.
Initial mean %HbF in ELGANs (n=16) was 92.2±1.3% (range 90.2-95.1%), which is similar to the control group (n=25). Mean levels dropped to 61.1±11.1% (range 34.2-73.2%) after a single pRBC transfusion (n=9) and to a mean of 35.6±6.3% after an additional transfusion (n=5). %HbF levels trended upwards if no additional transfusions were given, but levels still remained lower than expected for gestational age through discharge (n=85 samples).
Percent fetal hemoglobin concentrations in ELGANs decrease precipitously after transfusion with adult donor pRBCs. Further studies are needed to evaluate the benefit of maintaining higher fetal hemoglobin concentrations in these patients and whether administration of HbF rather than adult donor pRBCs would improve patient outcomes.
本研究旨在评估极低胎龄新生儿（ELGAN）输注成人供体浓缩红细胞（pRBC）后胎儿血红蛋白（HbF）的百分比下降。
在择期手术前，对未输血的新生儿脐带血或外周血样本进行对照胎儿血红蛋白（%HbF）水平测量。对 ELGAN 进行前瞻性随访，并在残留的测试后全血细胞计数（CBC）标本上测量 %HbF。将 ELGAN %HbF 值与对照人群进行比较，并记录输血情况。
ELGAN 组（n=16）的初始平均 %HbF 为 92.2±1.3%（范围 90.2-95.1%），与对照组（n=25）相似。在接受单次 pRBC 输血（n=9）后，平均水平降至 61.1±11.1%（范围 34.2-73.2%），在接受额外输血（n=5）后降至平均 35.6±6.3%。如果不给予额外输血，%HbF 水平呈上升趋势，但在出院时仍低于预期的胎龄水平（n=85 个样本）。
ELGAN 输注成人供体 pRBC 后，胎儿血红蛋白浓度急剧下降。需要进一步研究以评估在这些患者中维持较高胎儿血红蛋白浓度的益处，以及是否给予 HbF 而不是成人供体 pRBC 会改善患者的结局。
