Red Blood Cell (RBC) Survival Following Transfusion in Infants

Study Description

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Brief Summary:

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 or disease	Intervention/treatment	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

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Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	140 participants
Allocation:	Non-Randomized
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Basic Science
Official Title:	Red Blood Cell Survival Following Transfusion in Infants
Study Start Date :	June 2008
Actual Primary Completion Date :	September 2014
Actual Study Completion Date :	September 2014

Arms and Interventions

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Arm	Intervention/treatment
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).

Outcome Measures

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Primary Outcome Measures :

1. 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. ]
2. RBC survival in days of multiple, distinct populations of transfused RBCs in premature infants. [ Time Frame: 20 minutes - 4 months ]
3. Long-term survival of transfused adult donor and fetal/placental RBCs in days in anemic newborn infants. [ Time Frame: 20 min - 6 months ]

Secondary Outcome Measures :

1. Positive antibody screen in response to biotin-labeled RBCs. [ Time Frame: 5 min - 6 mo post transfusion of biotin RBCs ]
2. Survival of RBCs in days as measured by the differential agglutination, antigenic method [ Time Frame: 5 min to 5 months ]

Eligibility Criteria

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Ages Eligible for Study:	up to 6 Months (Child)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

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:

MOTHERS FOR PLACENTAL BLOOD COLLECTION AND MOTHERS OF INFANT STUDY SUBJECTS

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.

INFANT STUDY SUBJECTS

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.

Contacts and Locations

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Locations

United States, Iowa
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States, 52242
University of Iowa
Iowa City, Iowa, United States, 52242

Sponsors and Collaborators

University of Iowa

National Institutes of Health (NIH)

National Heart, Lung, and Blood Institute (NHLBI)

Thrasher Research Fund

Investigators

Principal Investigator:	John A Widness, MD	University of Iowa

More Information

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Publications of Results:

Mock DM, Matthews NI, Strauss RG, Burmeister LF, Schmidt R, Widness JA. Red blood cell volume can be independently determined in vitro using sheep and human red blood cells labeled at different densities of biotin. Transfusion. 2009 Jun;49(6):1178-85. doi: 10.1111/j.1537-2995.2009.02095.x. Epub 2009 Feb 10.

Mock DM, Matthews NI, Zhu S, Burmeister LF, Zimmerman MB, Strauss RG, Schmidt RL, Nalbant D, Cress GA, Widness JA. Red blood cell (RBC) volume can be independently determined in vivo in humans using RBCs labeled at different densities of biotin. Transfusion. 2011 Jan;51(1):148-57. doi: 10.1111/j.1537-2995.2010.02770.x.

Mock DM, Matthews NI, Zhu S, Strauss RG, Schmidt RL, Nalbant D, Cress GA, Widness JA. Red blood cell (RBC) survival determined in humans using RBCs labeled at multiple biotin densities. Transfusion. 2011 May;51(5):1047-57. doi: 10.1111/j.1537-2995.2010.02926.x. Epub 2010 Nov 9.

Mock DM, Lankford GL, Matthews NI, Burmeister LF, Kahn D, Widness JA, Strauss RG. Accelerated removal of antibody-coated red blood cells from the circulation is accurately tracked by a biotin label. Transfusion. 2012 May;52(5):1097-105. doi: 10.1111/j.1537-2995.2011.03397.x. Epub 2011 Oct 24.

Mock DM, Widness JA, Strauss RG, Franco RS. Posttransfusion red blood cell (RBC) survival determined using biotin-labeled RBCs has distinct advantages over labeling with (51) Cr. Transfusion. 2012 Jul;52(7):1596-8. doi: 10.1111/j.1537-2995.2012.03588.x.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Widness JA, Kuruvilla DJ, Mock DM, Matthews NI, Nalbant D, Cress GA, Schmidt RL, Strauss RG, Zimmerman MB, Veng-Pedersen P. Autologous Infant and Allogeneic Adult Red Cells Demonstrate Similar Concurrent Post-Transfusion Survival in Very Low Birth Weight Neonates. J Pediatr. 2015 Nov;167(5):1001-6. doi: 10.1016/j.jpeds.2015.08.028. Epub 2015 Sep 9.

Responsible Party:	University of Iowa
ClinicalTrials.gov Identifier:	NCT00731588 History of Changes
Other Study ID Numbers:	200710747; 2P01HL046925 ( U.S. NIH Grant/Contract )
First Posted:	August 11, 2008
Last Update Posted:	December 25, 2014
Last Verified:	December 2014

Additional relevant MeSH terms:

Anemia, Neonatal; Anemia; Hematologic Diseases; Infant, Newborn, Diseases; Biotin	Vitamin B Complex; Vitamins; Micronutrients; Growth Substances; Physiological Effects of Drugs