Variability in splanchnic tissue oxygenation during preterm red blood cell transfusion given for symptomatic anaemia may reveal a potential mechanism of transfusion-related acute gut injury

Authors

Sean M. Bailey, New York University School of MedicineFollow
Karen D. Hendricks-Muñoz, Virginia Commonwealth University
Pradeep V. Mally, New York University School of Medicine

Document Type

Article

Original Publication Date

2015

Journal/Book/Conference Title

Blood Transfusion

Volume

13

DOI of Original Publication

10.2450/2015.0212-14

Comments

Originally published at http://dx.doi.org/10.2450/2015.0212-14

Date of Submission

November 2015

Abstract

Background

There is increasing evidence indicating an association between red blood cell (RBC) transfusions and necrotising enterocolitis (NEC) in preterm infants, especially late-onset NEC. This phenomenon is referred to as transfusion-related acute gut injury (TRAGI). One theory as to a pathophysiological mechanism is that transfusion may result in an ischemia-reperfusion injury to intestinal tissue. We tested the hypothesis that there is significantly greater variability during transfusion in splanchnic tissue oxygen saturation (SrSO2) than in cerebral tissue oxygen saturation (CrSO2).

Materials and methods

This was a prospective, observational study using near-infrared spectroscopy to monitor SrSO2 and CrSO2in preterm neonates undergoing RBC transfusion for symptomatic anaemia. Mean, standard deviation, highest and lowest SrSO2 and CrSO2 values during each transfusion were determined. The greatest difference in SrSO2 and CrSO2 during each transfusion was calculated, along with the coefficient of variation.

Results

We studied 37 subjects. Throughout all transfusions, the mean SrSO₂ was 45.6% ±13.8 and the mean CrSO₂ was 65.4% ±6.9 (p<0.001). The variability of SrSO₂ was significantly greater than that of CrSO₂. Averaging data from all subjects, the greatest difference in SrSO₂ was 43.8% ±13.4 compared with 23.3% ±7.6 for CrSO₂ (p<0.001). The mean coefficient of variation in all transfusions was 20.5% for SrSO₂and 6.0% for CrSO₂ (p<0.001). Increasing post-conceptional age did not affect SrSO₂ variability (R2=0.022; p=0.379), whereas CrSO₂ variability during transfusion decreased with increasing post-conceptional age (R2=0.209; p=0.004).

Discussion

In preterm infants, there is a large degree of tissue oxygenation variability in splanchnic tissue during RBC transfusion and this does not change with increasing maturity. We speculate that these findings, combined with lower average tissue oxygenation, may demonstrate susceptibility of the preterm gut to TRAGI.

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Is Part Of

VCU Pediatrics Publications