Anemia Not Transfusion is Associated with Necrotizing Enterocolitis

Transfusion-related acute gut injury (TRAGI) is defined as the occurrence of necrotizing enterocolitis (NEC) 48 hours or less after a packed red blood cell (PRBC) transfusion for marked anemia in older, low-risk infants born at extremely low gestational ages (<28 weeks’ gestational age) who are no longer experiencing any historically associated risk factors except enteral feeding. Previous studies have suggested that RBC transfusion was a risk factor for development of TRAGI.

A recent prospective multicenter observational cohort study of 598 very low birth weight  (VLBW) infants reported that forty four (7.4%) infants developed NEC. Fifty three percent of infants (319) received a total of 1430 RBC transfusion exposures. The cumulative incidence of NEC at week 8 was 9.9% of infants who were transfused and 4.6% of those not transfused. The rate of NEC was significantly increased among VLBW infants with severe anemia, which was defined as hemoglobin of 8 g/dL or less. Multivariable analysis demonstrated that RBC transfusion in a given week was not significantly related to the incidence of NEC. The authors concluded that severe anemia, but not RBC transfusion, was associated with an increased risk of NEC in VLWBW infants.

Reference

Patel RM, etal. Association of red blood cell transfusion, anemia and necrotizing enterocolitis in very-low-birth-weight infants. JAMA. 2016;315(9):889-897. doi:10.1001/jama.2016.1204.