Hepatic iron storage in very low birthweight infants after multiple blood transfusions
P C Nga, C W K Lamb, C H Leea, K F Toc, T F Foka, I H S Chanb, E Wongd
a Department
of Paediatrics, Prince of Wales Hospital, Chinese University of Hong
Kong, b Department of Chemical Pathology, c Department of Anatomical
and Cellular Pathology, d Centre
for Clinical Trials and Epidemiological Research
Correspondence to: Professor Ng, Department of Paediatrics, Level 6, Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong pakcheungng{at}cuhk.edu.hk
Accepted 8 November
2000
OBJECTIVE
To
investigate the effect of multiple blood transfusions on hepatic iron
storage in preterm, very low birthweight (VLBW) infants.
METHODSSeventeen VLBW
infants who died within the first six months of life and underwent
postmortem examination were studied. Serum ferritin, iron, and total
iron binding capacity were measured within the week before the
infants' death. Liver iron concentration was quantitatively determined
by atomic absorption spectrophotometry and semiquantitatively assessed
by histochemical liver iron grading. The clinical characteristics and
the iron results were compared between infants receiving < 100 ml of
blood (group A) and those receiving 
100 ml (group B). Spearman's
correlation coefficient was used to evaluate the relation between the
volume of blood transfused and serum/liver iron concentrations.
Statistically significant variables associated with liver iron
concentration were further subjected to multivariate stepwise
regression analysis.
RESULTSInfants in
group B had significantly higher serum iron (p < 0.01), serum
ferritin (p < 0.01), and liver iron concentration (p < 0.01) than
those in group A. The total and net volume of blood transfused were
significantly associated with liver iron concentration (p < 0.001,
r = 0.86; p < 0.001,
r = 0.71 respectively), semiquantitative
histochemical liver iron grading (p < 0.001, r = 0.80; p < 0.005,
r = 0.71 respectively), and serum ferritin (p < 0.001, r = 0.84; p < 0.01,
r = 0.69 respectively). In addition, both
liver iron concentration and liver iron grading were found to be
significantly associated with serum ferritin (p < 0.001, r = 0.76; p < 0.005,
r = 0.68 respectively). Multivariate
stepwise regression analysis indicated that the (log) liver iron
concentration was significantly associated with the (log) volume of
blood transfusion (p < 0.001; regression coefficient 0.39, SE 0.09),
after adjustment for gestational age
(R2 = 0.84).
CONCLUSIONSThis study
showed a significant positive relation between the volume of blood
transfused and the liver iron concentration in preterm VLBW infants.
Although the transfusional blood volume correlated closely with the
amount of iron deposited in hepatic tissues, clinical manifestations of
iron overload were not observed. Carers should be aware of this
potential harmful effect before prescribing blood or routine iron
supplement to vulnerable preterm infants.
Keywords: blood transfusion; ferritin; liver; iron; preterm; very low birthweight
© 2001 by Archives of Disease in Childhood
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Collard, K. J.
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