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

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Submission ID :
ESPR86
Submission Type
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Abstract: :

Background:


Extremely low birth weight (ELBW) infants often receive packed red blood cells (PRBC) transfusions in the Neonatal Intensive Care Unit (NICU). Long-term outcomes of infants treated with liberal versus restricted criteria for PRBC transfusion have been evaluated, with conflicting results. Reticulocyte count (RC) is commonly ordered for evaluating anemia in growing premature babies. Many clinicians incorporate RC in their decision whether or not to transfuse. There is a lack of information on reference ranges for RC in growing ELBW infants and whether infant's chronologic age (CA) or adjusted gestational age (AGA) generates a specific trend in the RC. 


Objective: 


Our aim is to evaluate whether there is a trend in RC in ELBW based on AGA and CA. 


Method:


A retrospective chart review of infants born 1/1/2017-12/31/2019 with birth weight (BW) 500-1000 grams was performed. We evaluated RC measured during their initial hospitalization in the NICU and performed analysis for trends in RC based on AGA and CA.



Results:


A total of 142 infants were identified with BW 500-1000 grams, of which 101 survived to discharge or transfer to another institution and had RC performed. The GA (mean±SD) was 26.4±2.2 weeks. A total of 738 RCs were done with a mean of 7.3±3.1 per infant. The initial RC was done on the 4th or the 5th  week of life in the majority of infants (73%) . As the GA increased, the week of life of the first RC decreased. Thirty-three infants (33%) never received PRBC during their hospitalization. The mean individual lowest RC was (3.7±1.6) while the mean highest RC was (11.2±3.8). We observed that the week of life and GA had a negative curvilinear relationship with the RC (beta = -1.47, p <0.001 and beta = -5.21, p <0.001 respectively). Given this relationship, in the graphs, we observe a positive trend in RC values that reaches a peak and then experiences a downward trend. RCs at AGA and week of life are depicted in the graphs. 


Conclusion:


Although there were variations in the values of the RC in this cohort, we observed a decrease over time when the mean values were evaluated for the AGA or CA. In our cohort, RCs were not done in the first week of life, a factor that may have an effect on the observed trends of RC and transfusion intervention. Our report sheds the light on a common test that is theoretically helpful but needs guidelines on the appropriate frequency of testing and its utility in making transfusion decisions in ELBW infants.  

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Cooper University Hospital
Cooper University Hospital
Cooper University Hospital
Cooper University Hospital
The Children's Regional Hospital at Cooper
Cooper University Hospital

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