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Safer blood transfusions for preterm babies

Blood transfusions are one of the most common medical treatments required by preterm infants. Although the procedure undoubtedly saves many lives, emerging evidence suggests damage to the baby’s developing organ systems may be an associated risk.

Associate Professor Michael Stark from the Robinson Institute’s Neonatal Medicine Group is interested in determining why the potential side effects of blood transfusions occur. In 2012 he published the first evidence that receiving blood products triggers a surge in levels of inflammatory molecules in preterm infants. Michael recommends that more research is urgently required to better manage and ideally prevent this response.

Every year in Australia about 8% of babies are born before 37 weeks of pregnancy, and classified as preterm. Many of these infants require intensive medical support to survive. Very early babies often need red blood cell transfusions due to anaemia or following blood loss. Although this procedure undoubtedly saves many lives, it can also initiate inflammatory processes. What leads to this development is not well understood.

Michael Stark, Neonatologist and researcher in the Robinson Institute’s Neonatal Medicine Group, is working to understand what triggers the effects of blood transfusions in preterm infants. In 2012 he published a study that revealed transfusion elicits a cascade of infl ammatory changes.

“Within two to four hours of preterm babies receiving a blood transfusion, we have seen elevated levels of molecules known as cytokines and chemokines that in turn stimulate further inflammatory responses in the body,” Michael says.

Michael believes that once such molecules are triggered in the hours following a blood transfusion, they act within the child’s body to initiate high levels of inflammation that results in damage to blood vessels and tissue structures. Such events contribute to the development of signifi cant conditions that complicate very preterm birth, such as bronchopulmonary dysplasia in the lungs and necrotising entercolitis in the gut.

Although Michael has not yet determined exactly which components of blood transfusion trigger the inflammation, he has a theory.

“We believe that the bioactive components of packed red blood cell transfusions are initiating or amplifying these inflammatory processes in the body,” he suggests.

Possibilities include microparticles, iron or fatty molecules known as phospholipids that accumulate over time. More work is required to explore this further and determine how best to address the clinical challenges posed by blood transfusion in preterm babies.

“More research is now needed to determine exactly how this response is triggered, and how we might be able to prevent it,” said Michael.

“We hope that by better understanding how the body responds to the blood, we can make improvements to blood transfusions that will reduce the likelihood of inflammatory responses. In this way, the patient will benefi t from a life-saving procedure and also experience fewer complications.”

Despite the need for ongoing research, Michael emphasises the critical role that transfusions still play in the management of preterm infants.

“Blood transfusions are a safe and lifesaving medical procedure – they are an important part of modern-day medical care,” he said.

“We’d just like to be able to prevent and manage their side effects a little better.”

Michael’s study was conducted at the Women and Children’s Hospital in Adelaide, and included infants born before 28 weeks of gestation that were clinically-indicated to require blood transfusion. The research was undertaken in collaboration with the Australian Red Cross Blood Service and supported by the Australian & New Zealand Society of Blood Transfusion Ltd and The Robinson Institute.

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