Anticoagulant-Preservative Solution, Pretransfusion Hemoglobin Tied to Morbidity and Mortality in VLBW Infants: JAMA
USA: Researchers have found in a cohort study that most donor characteristics and blood banking practices were not associated with serious morbidity or mortality in very low birth weight (VLBW) infants receiving red blood cell (RBC) transfusions. However, pretransfusion hemoglobin levels and the type of anticoagulant-preservative solution used were linked to a combined outcome of major morbidities and mortality, suggesting these may be important and potentially modifiable factors.
Additionally, certain donor and blood banking variables were associated with specific individual outcomes, highlighting potential targets for future research and optimization of transfusion practices in this vulnerable population.
The findings were published in JAMA Network Open by Jeanne E. Hendrickson from the Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia, and colleagues. The researchers investigated whether modifiable donor, blood banking, and transfusion-related factors were associated with adverse outcomes in very-low-birth-weight infants.
The prospective Transfusion in Preterm Infants cohort study included 2,605 infants weighing less than 1,500 g at birth, of whom 1,283 received at least one RBC transfusion, across eight US hospitals. Researchers evaluated donor characteristics, anticoagulant-preservative solutions, blood storage practices, transfusion volume, number of transfusions, and pretransfusion hemoglobin levels.
The primary outcome was a composite of severe intraventricular hemorrhage, necrotizing enterocolitis, late-onset sepsis, severe bronchopulmonary dysplasia, retinopathy of prematurity, or death, with infants followed for up to 90 days or until death.
The study led to the following findings:
- Higher pretransfusion hemoglobin levels were associated with increased odds of the composite outcome of major morbidity or mortality.
- Use of AS-1 or AS-5 anticoagulant-preservative solutions was associated with a lower risk of the composite outcome compared with citrate phosphate dextrose-based solutions.
- Most donor characteristics and blood banking practices were not associated with the composite outcome.
- AS-1 and AS-5 solutions were associated with a lower risk of severe bronchopulmonary dysplasia.
- AS-3 solution was associated with a higher risk of necrotizing enterocolitis.
- Larger transfusion volumes were associated with an increased risk of mortality.
- Blood from donors aged 60 years or older was associated with a lower risk of mortality.
- Blood transfused within one day after irradiation was associated with a lower risk of necrotizing enterocolitis.
- Blood from female donors was associated with a lower risk of severe intraventricular hemorrhage.
The researchers acknowledged several limitations, including the use of a composite outcome, potential unmeasured confounding factors, and the exploratory nature of the secondary analyses, which may have been influenced by small sample sizes.
The authors concluded that pretransfusion hemoglobin levels and the anticoagulant-preservative solution were the only modifiable transfusion-related factors associated with major morbidity or mortality in very-low-birth-weight infants. Although most donor and blood banking characteristics were not linked to overall outcomes, some were associated with specific complications and warrant further investigation.
Reference:
Hendrickson JE, Birch RJ, Rowley EAK, et al. Red Blood Cell Transfusion Characteristics and Morbidity or Mortality in Very-Low-Birth-Weight Infants. JAMA Netw Open. 2026;9(6):e2619301. doi:10.1001/jamanetworkopen.2026.19301
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