Freshly irradiated RBC transfusion shows better cerebral oxygenation in preterm infants: JAMA

New Zealand: In a new study conducted by Maria Saito-Benz and team it was found that when compared to transfusion of irradiated and stored red blood cell components, transfusion of freshly irradiated RBCs offered a slight benefit in cerebral oxygenation for at least 5 days following transfusion. The findings of this study were published in the Journal of American Medical Association.

Gamma irradiation of leuko-reduced RBC decreases transfusion-based graft-vs-host disease but also accelerates the establishment of storage lesions in RBCs. In preterm newborns with high transfusion needs, it is uncertain if freshly irradiated RBCs are more effective than irradiated and stored RBCs. As a result, this study was designed to see if transfusion of freshly irradiated RBC components vs irradiated and stored RBC components improved cerebral oxygen supply in preterm babies with anemia.

Between December 1, 2017, and November 30, 2018, a double-blind, single-center, proof-of-concept randomized clinical study was undertaken at Wellington Regional Hospital's newborn critical care unit in Wellington, New Zealand. Participants were preterm newborns with anemia who were at least 14 days old. Participants received non-urgent transfusions, and these events were randomly assigned to either the intervention or control groups. The evaluable population technique was used to examine the data. This study explored transfusion of newly irradiated RBCs.

The key findings of this study were as follows:

1. The trial included 42 babies who had 64 transfusion sessions and were randomly assigned to the intervention (n = 31) or control (n = 33) groups.

2. Immediately after transfusion, babies in the intervention group had a covariate-adjusted mean rise in crSO2 and a mean reduction in cFTOE (0.02; 95% CI, 0.01-0.04) compared to those in the control group.

3. These disparities lasted for 120 hours, or 5 days, after the transfusion.

4. At all of the follow-up time periods, babies in the control group had minimal mean changes in crSO2 or cFTOE.

In conclusion, on-demand irradiation of RBC elements may be explored to enhance oxygen supply in the recipient, however, this physiological discovery has to be investigated further.

Reference:

Saito-Benz M, Bennington K, Gray CL, et al. Effects of Freshly Irradiated vs Irradiated and Stored Red Blood Cell Transfusion on Cerebral Oxygenation in Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. Published online March 28, 2022. doi:10.1001/jamapediatrics.2022.0152