Iron homeostasis after blood transfusion in stable preterm infants - an observational study

Aim: To evaluate the short-term effects of blood-transfusion on iron status [hemoglobin, ferritin, soluble transferrin receptor (sTfR), and reticulocyte count], hepcidin, and erythropoietin in stable preterm infants. Method: Sixty-three preterm infants treated with red blood cell transfusions (RBCTs) were included. Venous blood samples were collected before and within 24 h after each transfusion. Results: Hemoglobin concentration increased after RBCT (7.2 +/- 1.2 g/dL vs. 13.7 +/- 2.3 g/dL, P = 0.02), as well as ferritin [131 (63-110.4) ng/mL vs. 211 (125.7-299.2) ng/mL, P = 0.05); reticulocyte count decreased. sTfR did not change. Hepcidin serum levels increased from 37.5 (21.3-84.7) ng/mL to 72.6 (31.3-126.2) ng/mL, (P = 0.04) and erythropoietin decreased (48 +/- 19 pg/mL vs. 29 +/- 17 pg/mL, P = 0.06) after RBCT. A positive linear correlation was found (R-2 = 0.76, P = 0.0001) between hepcidin and ferritin levels of postminus-pre RBCT. Hepcidin levels increased significantly in preterm infants who received RBCT after 1 month of age compared to those who received RBCT at < 1 month (P = 0.03). No correlation was found between gestational age, weight appropriate for age, or length of blood storage and hepcidin levels. Conclusion: Preterm infants can control iron levels by regulating hepcidin and decreasing erythropoietin. This ability varies with postnatal age.