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Schinagl, Carina (2015): Microcirculatory assessment of red blood cell transfusion in children with severe anemia. Dissertation, LMU München: Medizinische Fakultät



Background: Pediatric hematology patients frequently receive red blood all transfusions for severe anemia. Our goal was to assess the effect of blood transfusion on the microcirculation and thus provide information on the quality of tissue perfusion. Methods and patients: The sublingual microcirculation was visualized with Sidestream-Darkfield Imaging in 20 anemic (Hb: 7.2 g/dL, 95% CI 6.6-7.9) children receiving red blood cell transfusions and in age matched healthy non-anemic controls. Functional vessel density (FVD) was determined with a semiautomatic program. Results: Immediately after transfusion FVD increased (13.4 versus 15 mm/mm2) and RBC velocity (696 (598-792) versus 628 (549-707) μm/s) decreased but FVD was always significantly lower and RBC velocity was always higher than in the age matched control group (FVD 17 mm/mm2; RBC velocity: 486 (441-530) μm/s). FVD at baseline was lower in patients with infections but with a larger increase after transfusion compared to anemic children without infections (∆FVD 3.4 versus ∆FVD 1.3 mm/mm2). Hemoglobin levels and capillary density correlated well. We did see a larger rise in FVD with transfusion of RBCs aged < 12 days. Conclusion: Whereas conventional monitoring methods may not be able to assess the effect of therapies aimed to improve tissue perfusion, SDF imaging can demonstrate improvements after transfusion but also continuous differences to non-anemic controls. In particular, the microcirculation of anemic oncology patients with infection improves after transfusion. Transfusion thresholds might need to be set higher in in such patients and fresh RBCs < 12 day of storage should be used.