Download PDF
Am J Perinatol 2023; 40(15): 1638-1643
DOI: 10.1055/a-1653-4585
Original Article

Reticulocyte Count: The Forgotten Factor in Transfusion Decisions for Extremely Low Birth Weight Infants

Daniel Nakhla
1   Rutgers University, The State University of New Jersey, New Jersey
,
Alla Kushnir 
2   Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
,
Rafat Ahmed
2   Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
,
Vineet Bhandari
2   Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
,
Krystal Hunter
2   Division of Neonatology, Children's Regional Hospital at Cooper University Hospital, Camden, New Jersey
,
Tarek Nakhla
3   CHOP Newborn services at Virtua Hospital, Voorhees, New Jersey
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Extremely low birth weight (ELBW) infants often receive transfusions of packed red blood cells (PRBCs). Long-term outcomes of infants treated with liberal versus restricted transfusion criteria have been evaluated with conflicting results. Clinicians incorporate a reticulocyte count (RC) in their transfusion decisions. There is a lack of information on reference ranges for RCs in growing ELBW infants and whether infant's chronologic age or corrected gestational age (GA) generates a specific trend in the RCs. Our aim was to evaluate the levels of RCs obtained from ELBW infants over the course of the initial hospitalization.

Study Design A retrospective chart review of ELBW infants treated in the neonatal intensive care unit (NICU) and had RCs performed. We analyzed the RCs to observe trends based on the chronologic age and corrected GA.

Results A total of 738 RCs were analyzed. A positive trend in RCs that reached a peak at 32 to 34 weeks' corrected GA and then experienced a downward trend was observed.

Conclusion Our report examines a very common hematologic test that is theoretically helpful but is in need of guidelines concerning the appropriate frequency of testing and its utility in making transfusion decisions in ELBW infants.

Key Points

  • RCs should help in making transfusion decisions for ELBW infants.

  • No current reference ranges for RC in this population.

  • No current reference ranges for RC based on GA and postnatal age.

Keywords

ELBW - reticulocyte count - PRBC transfusion - gestational age


Publication History

Received: 05 September 2021

Accepted: 23 September 2021

Accepted Manuscript online:
24 September 2021

Article published online:
23 November 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Christensen RD. Expected hematologic values for term and preterm neonates. In: Christensen RD. ed. Hematologic Problems of the Neonate, 1st ed. Philadelphia, PA: W.B. Saunders; 2000: 117-136
    Google Scholar
  • 2 MacQueen BC, Henry E, Sola-Visner MC. et al. Using the new complete blood count parameters in neonatal intensive care unit practice. In: Ohls RK. ed. Neonatology Questions and Controversies Series, Hematology, Immunology and genetics, 3rd ed. Philadelphia, PA: Elsevier; 2019: 75-86
    Google Scholar
  • 3 Buttarello M. Laboratory diagnosis of anemia: are the old and new red cell parameters useful in classification and treatment, how?. Int J Lab Hematol 2016; 38 (Suppl. 01) 123-132
    CrossrefPubMedGoogle Scholar
  • 4 Kirpalani H, Bell EF, Hintz SR. et al; Eunice Kennedy Shriver NICHD Neonatal Research Network. Higher or lower hemoglobin transfusion thresholds for preterm infants. N Engl J Med 2020; 383 (27) 2639-2651
    CrossrefPubMedGoogle Scholar
  • 5 Al-Ghananim RT, Nalbant D, Schmidt RL, Cress GA, Zimmerman MB, Widness JA. Reticulocyte hemoglobin content during the first month of life in critically ill very low birth weight neonates differs from term infants, children, and adults. J Clin Lab Anal 2016; 30 (04) 326-334
    CrossrefPubMedGoogle Scholar
  • 6 Maheshwari A, Patel RM, Christensen RD. Anemia, red blood cell transfusions, and necrotizing enterocolitis. Semin Pediatr Surg 2018; 27 (01) 47-51
    CrossrefPubMedGoogle Scholar
  • 7 Englert JA, Saunders RA, Purohit D, Hulsey TC, Ebeling M. The effect of anemia on retinopathy of prematurity in extremely low birth weight infants. J Perinatol 2001; 21 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 8 Kalteren WS, Kuik SJ, Van Braeckel KNJA. et al. Red blood cell transfusions affect intestinal and cerebral oxygenation differently in preterm infants with and without subsequent necrotizing enterocolitis. Am J Perinatol 2018; 35 (11) 1031-1037
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Howarth C, Banerjee J, Aladangady N. Red blood cell transfusion in preterm infants: current evidence and controversies. Neonatology 2018; 114 (01) 7-16
    CrossrefPubMedGoogle Scholar
  • 10 Lust C, Vesoulis Z, Jackups Jr. R, Liao S, Rao R, Mathur AM. Early red cell transfusion is associated with development of severe retinopathy of prematurity. J Perinatol 2019; 39 (03) 393-400
    CrossrefPubMedGoogle Scholar
  • 11 Bell EF, Strauss RG, Widness JA. et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 2005; 115 (06) 1685-1691
    CrossrefPubMedGoogle Scholar
  • 12 Westkamp E, Soditt V, Adrian S, Bohnhorst B, Groneck P, Poets CF. Blood transfusion in anemic infants with apnea of prematurity. Biol Neonate 2002; 82 (04) 228-232
    CrossrefPubMedGoogle Scholar
  • 13 Bromiker R, Kasinetz Y, Kaplan M, Hammerman C, Schimmel M, Medoff-Cooper B. Sucking improvement following blood transfusion for anemia of prematurity. Arch Pediatr Adolesc Med 2012; 166 (10) 897-901
    CrossrefPubMedGoogle Scholar
  • 14 James L, Greenough A, Naik S. The effect of blood transfusion on oxygenation in premature ventilated neonates. Eur J Pediatr 1997; 156 (02) 139-141
    CrossrefPubMedGoogle Scholar
  • 15 Christensen RD, Henry E, Bennett ST, Yaish HM. Reference intervals for reticulocyte parameters of infants during their first 90 days after birth. J Perinatol 2016; 36 (01) 61-66
    CrossrefPubMedGoogle Scholar
  • 16 Jopling J, Henry E, Wiedmeier SE, Christensen RD. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics 2009; 123 (02) e333-e337
    CrossrefPubMedGoogle Scholar
  • 17 Schiza V, Giapros V, Pantou K, Theocharis P, Challa A, Andronikou S. Serum transferrin receptor, ferritin, and reticulocyte maturity indices during the first year of life in ‘large’ preterm infants. Eur J Haematol 2007; 79 (05) 439-446
    CrossrefPubMedGoogle Scholar
  • 18 Lorenz L, Peter A, Arand J, Springer F, Poets CF, Franz AR. Reference ranges of reticulocyte hemoglobin content in preterm and term infants: a retrospective analysis. Neonatology 2017; 111 (03) 189-194
    CrossrefPubMedGoogle Scholar
  • 19 Kirpalani H, Whyte RK, Andersen C. et al. The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr 2006; 149 (03) 301-307
    CrossrefPubMedGoogle Scholar
  • 20 Bishara N, Ohls RK. Current controversies in the management of the anemia of prematurity. Semin Perinatol 2009; 33 (01) 29-34
    CrossrefPubMedGoogle Scholar
  • 21 Nopoulos PC, Conrad AL, Bell EF. et al. Long-term outcome of brain structure in premature infants: effects of liberal vs restricted red blood cell transfusions. Arch Pediatr Adolesc Med 2011; 165 (05) 443-450
    CrossrefPubMedGoogle Scholar
  • 22 Whyte RK, Kirpalani H, Asztalos EV. et al; PINTOS Study Group. Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics 2009; 123 (01) 207-213
    CrossrefPubMedGoogle Scholar
  • 23 Christensen RD, Jopling J, Henry E, Wiedmeier SE. The erythrocyte indices of neonates, defined using data from over 12,000 patients in a multihospital health care system. J Perinatol 2008; 28 (01) 24-28
    CrossrefPubMedGoogle Scholar