Randomized trial assessing the feasibility and safety of biologic parents as RBC donors for their preterm infants

BACKGROUND: Most very low birth weight (<1.0 kg) infants receive RBC transf usions. Several reports have demonstrated that RBCs stored up to 42 days ca n be transfused safely in small volumes to preterm infants to decrease dono r exposure without consequent hyperkalemia, acidosis, or other adverse effe cts. Although biologic parents are likely candidates as donors of blood for their neonates, it has been suggested that their blood may be serologicall y incompatible with that of their infants. STUDY DESIGN AND METHODS: A two-arm randomized study was conducted to compa re the feasibility and immediate safety of two single-donor programs for pr oviding small-volume RBC transfusions to preterm infants: in one arm, infan ts received RBCs collected from unrelated donors and stored up to 42 days, and in the other arm, RBCs were collected from one of the biologic parents and stored identically. All infants received compatible RBCs that were WBC reduced before storage, stored in AS-3, and gamma-radiated. All transfusion s were given uniformly as 15 mt per kg of RBCs transfused over 5 hours, dur ing which time the infants were closely observed for clinical reactions. In addition, laboratory studies were performed shortly before and after each transfusion. RESULTS: A total of 40 preterm infants received 120 RBC transfusions. Biolo gic parents experienced several donor eligibility problems. However, once e nrolled as donors, they were able to supply all RBCs needed by their infant s. Significant differences in rates of clinical transfusion reactions and l aboratory abnormalities were rare and had no apparent clinical importance, regardless of whether RBCs were donated by biologic parents or unrelated do nors. CONCLUSION: A single-donor system, in which AS-3 RBCs were collected either from unrelated blood donors or from biologic parents and then stored up to 42 days, was able to supply small-volume RBC transfusions needed by indivi dual preterm infants without immediate, adverse effects. Because the risk o f infectious disease transmission is likely reduced by limiting donor expos ure, it is logical to conclude that single-donor programs should increase t ransfusion safety and that biologic parents should be considered as blood d onors for their infants.