Background
Transfusion related immunomodulation (TRIM), characterised by a pro-inflammatory response in the transfusion recipient, is an adverse consequence to red blood cells (RBCs) exposure. In adults and paediatric patients, transfusion with washed RBCs is associated with reduced morbidity and mortality potentially through a reduction in this immunomodulatory response. Whether a similar effect is seen in preterm neonates is unknown.
Methods
Transfusion naïve infants <30+0weeks’ gestation were randomised to receive washed (n=10) or standard (n=15) RBCs. Samples were collected from the pack and from infants prior and 4-6 hours post-transfusion for the first 3 transfusion exposures. IL1β, IL6 and TNFα were analysed using multiplex ELISA and Δ%[cytokine] calculated from the pre- and post-transfusion samples. Data were analysed blinded to group allocation.
Results
The Δ%[IL1β]decreased with each transfusion exposure in the washed group (p=0.03) with levels lower than the standard group by the 3rd transfusion (p=0.002). While no effect of time was seen in either group for Δ%[IL6] or Δ%[TNFα], levels were lower for the washed group following the 2nd(Δ%[IL6] p=0.02, Δ%[TNFα] p=0.03) and 3rd transfusions (Δ%[IL6] p=0.006, Δ%[TNFα] p=0.03).
Conclusion
While adverse neonatal outcome has been associated with RBC transfusion, with the risk increasing with cumulative transfusion exposure, the underlying mechanisms remain poorly understood. The reduction in a pro-inflammatory response following transfusion with washed RBCs, an effect that increases with subsequent transfusion exposure, would suggest this additional processing step limits TRIM and may therefore have the potential to reduce the adverse consequences to transfusion exposure in preterm newborn.