Evidence supports current transfusion practices for newborns

The Issue

Because of their immature immune systems, newborns have a higher risk of transfusion-associated graft-versus-host disease, where white blood cells from the transfusion produce immune cells that attack the recipient. To prevent this life-threatening condition, red blood cell units transfused to newborns are irradiated. Irradiation makes the red blood cells more fragile, so they are more likely to release their contents (such as potassium and hemoglobin) during storage. High levels of potassium can cause cardiac problems. Our researchers tested two methods that hospitals currently use to reduce potentially harmful substances from the irradiated units transfused to newborns.

The Evidence

The researchers centrifuged the irradiated units or allowed their content to settle naturally.  Due to their heavy mass, red blood cells preferentially settled at the bottom unlike small molecules like potassium. This increased the concentration of red blood cells in aliquots taken while reducing the amount of supernatant where potentially harmful substances, such as potassium, are located. Both methods reduced potassium and other substances to safe levels even in units stored for up to 21 days after irradiation. Interestingly, gravity-settled aliquots had higher levels of microvesicles compared with the original units. However, further research is required to determine whether this observation has clinical implications.

The Impact

This study confirms that current practice of centrifugating irradiated red blood cells to provide an aliquot for transfusion, provides a safe product for neonates. In addition to reducing potentially harmful substances, serial aliquots can be drawn from a single irradiated unit during its storage period, reducing waste and minimizing the donor exposure for newborns who require multiple transfusions.

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