Red Blood Cell (RBC) Survival Following Transfusion in Infants

This study has been completed.
Thrasher Research Fund
Information provided by (Responsible Party):
University of Iowa Identifier:
First received: August 5, 2008
Last updated: December 23, 2014
Last verified: December 2014

OUR OVERALL HYPOTHESIS is that post-transfusion survival of allogeneic and autologous RBCs can be accurately quantified in anemic human infants using biotin-labeled RBCs combined with mathematical modeling that adjusts for confounding factors commonly encountered in neonates. These confounding factors include 1) dilution of labeled RBC as a result of growth stimulated erythropoiesis, anemia stimulated erythropoiesis, and blood transfusion; 2) loss of labeled RBC due to laboratory phlebotomy; and 3) variable RBC life spans resulting from RBCs having been produced at different developmental periods and under varying rates of erythropoiesis. In contrast to infants, adjustment for these factors is not necessary in healthy adults under conditions of steady state erythropoiesis. Instead in adults, RBC survival is typified by a linear decline in concentration of labeled RBCs over time. When this line is extrapolated to zero concentration, the intercept with the time axis represents the mean potential lifespan (MPL) of RBCs. (<7 d) and stored (>21 d) allogeneic adult RBCs transfused in the same infant.

Condition Intervention Phase
Neonatal Anemia
Biological: Transfused Biotin RBCs - Adults Phase I
Biological: Transfused Biotin RBCs - Infants Phase II
Biological: Transfused Biotin RBCs - Infants Phase III
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Pharmacokinetics/Dynamics Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Basic Science
Official Title: Red Blood Cell Survival Following Transfusion in Infants

Resource links provided by NLM:

Further study details as provided by University of Iowa:

Primary Outcome Measures:
  • Measurement of biotinylated RBCs at up to 5 discrete densities by flow cytometry. [ Time Frame: from date of transfusion to disappearance of biotinylated RBCs in blood samples, typically 4 months. ] [ Designated as safety issue: No ]
  • RBC survival in days of multiple, distinct populations of transfused RBCs in premature infants. [ Time Frame: 20 minutes - 4 months ] [ Designated as safety issue: No ]
  • Long-term survival of transfused adult donor and fetal/placental RBCs in days in anemic newborn infants. [ Time Frame: 20 min - 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Positive antibody screen in response to biotin-labeled RBCs. [ Time Frame: 5 min - 6 mo post transfusion of biotin RBCs ] [ Designated as safety issue: Yes ]
  • Survival of RBCs in days as measured by the differential agglutination, antigenic method [ Time Frame: 5 min to 5 months ] [ Designated as safety issue: No ]

Enrollment: 140
Study Start Date: June 2008
Study Completion Date: September 2014
Primary Completion Date: September 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: PPG1A - Adults
Phase I completed: Healthy male and post-menopausal female volunteers between the ages of 18 and 65. Volunteers must not have donated blood in the previous 8 weeks.
Biological: Transfused Biotin RBCs - Adults Phase I
A 3 mL venous blood sample is obtained. 250 mL of blood will be drawn to a blood collection bag containing the anticoagulant CPD. Separate equal volumes of RBCs are labeled with up to five different densities of biotin. The biotinylated RBCs are resuspended in autologous plasma to achieve a 60 to 70% hematocrit. An IV is inserted for the reinfusion of the biotinylated RBCs. Three mL aliquots of blood are sampled at 5, 10, 20, and 60 minutes after infusion. The subject returns ~24 hours and 3 days after the RBC infusion to obtain a 3 mL venous blood sample. Subjects return for weekly 3 mL blood sampling.
Experimental: PPG1B - Infants
Phase II in progress: Newborns >= 24 weeks gestation who are patients in the Neonatal Intensive Care Unit at the University of Iowa Hospitals and Clinics that are being treated with the expectation of survival.
Biological: Transfused Biotin RBCs - Infants Phase II
After the infant's clinical care team decides that a RBC transfusion is needed, a 15mL/kilogram of body weight is ordered. Transfusion will be given in 2 parts: 1) approximately 80% of the total transfusion to be transfused over 3-4 hours and 2) approximately 20% of the total transfusion will be marked with biotin to be transfused upon completion of the first part. The bedside nurse maintains constant observation of the infant as appropriate for the infant's condition, assessing for signs and symptoms of a transfusion reaction.
Biological: Transfused Biotin RBCs - Infants Phase III
Phase III (infants) to be determined upon completion of Phase II (infants).

  Show Detailed Description


Ages Eligible for Study:   up to 6 Months
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Adult Study:

Inclusion Criteria:

  • Males or post-menopausal females
  • 18-65 years of age.
  • Weight >110 lbs.
  • Healthy- the subject feels well and can perform normal activities.
  • Hemoglobin at or above 12.5 g/dL or hematocrit at or above 38%.

    • Note: Members of the research team that are not supervised or under the employee of the PI may participate in the study.

Exclusion Criteria:

  • Presence of chronic illness unless the subject is being treated and the condition is under control.
  • Consumption of biotin supplements or raw eggs.
  • Premenopausal women.
  • Blood donation in the previous 8 weeks (single donation) or 16 weeks (double red cell donation).
  • Blood loss in the previous 8 weeks due to epistaxis, gastrointestinal blood loss, trauma, significant diagnostic phlebotomy loss (i.e., > 30 mL total), or other significant bleeding
  • Treatment with antibiotics within the last 7 days. Antibiotics for prevention of an infection or treatment of acne are not exclusion criteria.

    • Note: If study subjects experience any of these conditions associated with blood loss or donate any blood products, they will not be included in the primary analysis but will be replaced.

Infant Study:


Inclusion Criteria:

  1. >/= 24 weeks gestation
  2. mothers who deliver through the birthcanal or by c-section can be included in the study.

Exclusion Criteria:

  1. Pregnant with fetus with major congenital anomaly.
  2. Clinically suspected or documented maternal chorioamnionitis (This only applies to infant study subjects receiving autologous RBCs from the placenta).
  3. Viral or bacterial infection (e.g. HIV, Hepatitis B, Hepatitis C, Primary Herpes, Tuberculosis) based on clinically available prenatal or postnatal test results in the mother's medical record. (This only applies to infant study subjects receiving autologous RBCs from the placenta.)
  4. minor mothers (<18 years old) are excluded from the study.


Inclusion Criteria:

Newborns >/=24 weeks gestation who are patients in the Neonatal Intensive Care Unit (NICU) at UIHC that:

1) Are being treated with the expectation of survival.

Exclusion Criteria:

  1. Difference of more than 5% in the percentage of HbF cells (measured by flow cytometry in the Widness lab) between blood harvested from the placenta and that from discarded neonatal blood in the first day of life and before the first neonatal blood transfusion. This is done to exclude the rare possibility of transfusing newborns with blood that is contaminated with a significant proportion of their mother's blood if a maternal-to-placenta bleed occurs after umbilical cord clamping is done. (This only applies to infant study subjects receiving autologous RBCs from the placenta.)
  2. Need of emergent blood transfusion as determined by the subject's medical care team.
  3. Hematological diseases (except for anemia associated with phlebotomy loss and prematurity)
  4. Alloimmune hemolytic anemia, diffuse intravascular coagulation, and thrombosis.
  5. Major congenital anomaly.
  6. Sepsis with positive blood or spinal fluid culture.
  7. Receiving treatment with erythropoietin (r-HuEPO) or cardiorespiratory bypass support (ECMO).
  8. Overt clinical bleeding.
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Please refer to this study by its identifier: NCT00731588

United States, Iowa
University of Iowa
Iowa City, Iowa, United States, 52242
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States, 52242
Sponsors and Collaborators
University of Iowa
Thrasher Research Fund
Principal Investigator: John A Widness, MD University of Iowa
  More Information

Responsible Party: University of Iowa Identifier: NCT00731588     History of Changes
Other Study ID Numbers: 200710747, 2P01HL046925
Study First Received: August 5, 2008
Last Updated: December 23, 2014
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Anemia, Neonatal
Hematologic Diseases
Infant, Newborn, Diseases
Growth Substances
Pharmacologic Actions
Physiological Effects of Drugs
Vitamin B Complex
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