680 - Ferritin levels after Packed Red Blood Cell Transfusions in Very Low Birth Weight Infants

Publication Number: 680.4974

Shivani Patel, Keck School of Medicine of the University of Southern California, Chino, CA, United States; Smeeta Sardesai, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Lorayne Barton, Keck School of Medicine of USC/Los Angeles General Hospital, Los Angeles, CA, United States; Rowena Cayabyab, Los Angeles General Medical Center, Los Angeles, CA, United States

Background: Iron is required for the development of all organs, including the brain. Iron Deficiency (ID) is more severe in lower gestational age infants due to low levels of Epo, a shortened RBC survival, rapid postnatal growth and frequent phlebotomy. However, very low birth weight (VLBW) infants are at risk for possible iron overload. Studies have demonstrated a higher risk of iron overload in VLBW with multiple packed red blood cell (PRBC) transfusions in VLBW infants. Serum ferritin is an indicator of iron status and has been widely used in neonatal iron studies. AAP does not have any recommendations on iron supplementation after blood transfusion and thus more studies are needed to provide guidance for management.

Objective: To determine the relationship between packed red blood cell transfusions and ferritin values in VLBW infants.

Design/Methods: Retrospective study of VLBW infants admitted to the neonatal intensive care unit (NICU) at Los Angeles General Medical Center from June 2023 to July 2024 who had a ferritin level drawn during their NICU admission. Patients were divided into 2 groups: Gestational age (GA) < 28 weeks (EP), vs ≥28 weeks (non-EP). Data was collected on neonatal demographics, ferritin and CRP values, number of transfusions and time to start enteral iron. A ferritin value of > 267 μg/L was used as upper limit of normal. Data analysis was performed with the use of Wilcoxon rank sum for continuous data and Fischer exact for categorical variables. To predict ferritin levels, linear regression was used.

Results: Total of 53 ferritin levels were obtained from 30 patients (1-4 values per patient) during NICU admission. Median ferritin value was 100 (75, 170), obtained at median of 19 (14,22) days since PRBC transfusion. The median of number of PRBC transfusion was 2 (1,4) before the ferritin level was obtained. Babies who were EP were more likely to have transfusions earlier in postnatal life, have higher number of PRBC transfusions, delayed start of enteral iron, and ferritin levels drawn later in life compared to infants who are not EP. (Table) The number of transfusions predicted ferritin level (Coef 16, 95% CI [1.38-18.41] P= 0.03) after adjusting for GA, day of life ferritin was collected, C reactive protein and days since last transfusion. All Infants had normal ferritin values before the start of enteral iron.

Conclusion(s): Our study demonstrated that ferritin levels increase after transfusion and obtaining a level may provide an objective data to assess iron status in VLBW infants who have received multiple PRBC transfusions. Data collection is ongoing to increase sample size.

Table: Demographics and Clinical Characteristics of the Study population