The effect of transfusion of erythrocyte-containing blood components on the excretory function of the kidneys in children with anemia without bleeding

BACKGROUND. Excessive transfusions of red blood cells (RBC) for anemia without bleeding can lead to simultaneous changes of blood rheological properties in the form of its viscosity increase and, accordingly, to a change in the functional ability of the child's kidneys, taking into account functional and morphological immaturity by age, especially during oncological and hematological diseases treatment. THE AIM: to study the effect of increased hemoglobin (Hb) and hematocrit levels on excretory kidney function from a single RBC transfusion in children weighing up to 30 kg with oncological and hematological diseases. PATIENTS AND METHODS. The study included 753 RBC transfusions in 175 patients from 3 months to 11 years old, with a body weight of up to 30 kg, with anemia without bleeding. The spread of Hb growth was from 3 to 69 g/l, in 12.9 % of cases (n=97) increase in Hb was ≥31 g/l. The RBC dose range was from 3.76 to 21.59 ml/kg. RESULTS. With an increase of Hb ≥31 g/l in infants in 62.5 % of cases (n=10) decrease in glomerular filtration rate (GFR) to a maximum of 20 ml/min (22 % of the initial level) was identified, in children in 49.4 % of cases (n=40) to a maximum of 56 ml/min (30.6 % of the initial level). In the validation group (15 RBC transfusions in 15 patients), a comparison analysis of the Schwartz, Hoek, and combined Schwartz equations for GFR calculation was carried out. CONCLUSIONS. According to the validation data of GFR calculation methods, the Schwartz formula had sufficient accuracy for kidney function monitoring in dynamics in pediatric oncology. The level of Hb increase ≥31 g/l from a single dose RBC transfusion was classified as potentially unsafe for the correction of anemia without bleeding in children with oncological and hematological diseases.

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