From the Literature

 

Published: Oct 2019

Effects of blood transfusion on regional tissue oxygenation in preterm newborns are dependent on the degree of anaemia.
Aktas S, Ergenekon E, Ozcan E, et al.
J Paediatr Child Health 2019;55:1209-1213.
Pub Med
NATA rating :

 

REVIEW by:
J. Meier

 

NATA REVIEW:
What is the aim of transfusion? Increasing the haemoglobin concentration, increasing oxygen delivery, increasing tissue oxygenation, increasing oxygen consumption, or improving survival? This rather provocative question illustrates one of our problems regarding transfusion. All of our efforts should focus on rock-solid outcome parameters (e.g. survival), however in daily clinical practice we very often look only at the most easily accessible parameter: haemoglobin concentration.

In this study by Aktas and coworkers, another approach tested in preterm infants. The authors investigated the impact of the transfusion of red blood cells on tissue oxygenation in the brain, the abdomen and the kidneys by means of near-infrared spectroscopy.

As many others previously, they were able to demonstrate – in this very specific patient group – that the effect of RBC transfusion on tissue oxygenation is less pronounced than anticipated. Although the overall effects were quite small, they could distinguish between the effects on the brain and the abdomen/kidneys. Tissue oxygenation slightly improved for the abdomen and the kidney, but only small changes were observed for cerebral rSO2. Whether this represents a monitoring artifact or can be explained by changes in regional blood flow remains open for discussion. Furthermore, the authors attempted to distinguish the effects for different degrees of pretransfusion anaemia; however, the differences were more or less negligible.

Although this study has several shortcomings, it clearly demonstrates that the mantra "tissue oxygenation improvement by transfusion" does not necessarily hold true, and therefore the effects typically expected from transfusion cannot always be reached.


– Jens Meier