Effect of exchange transfusion on oxygen free radicals and some antioxidants in newborn infants

ABSTRACT

Exchange transfusion rapidly produces variable changes in pro-oxidants and antioxidants plasma concentrations in neonates which may be responsible for free radical metabolism. So our study aimed to evaluate the effect of exchange transfusion on some pro-oxidants [iron, and ferritin] and primary antioxidants [ceruloplasmin and transferrin] in newborn infants. The study included 25 neonates [16 males and 9 females] with mean gestational age of 34.4 +/- 3.9 weeks. They were divided into 2 groups according to clinical presentation, 17 with hyperbilirubinemia [6 haemolytic and 11 non haemolytic] and 8 hyperbilirubinemia with sepsis. All neonates were subjected to full clinical history, Gestational age assessment, thorough clinical examinations for all systems and laboratory investigations [before and after exchange transfusion] in the form of complete blood count, serum levels of total and direct bilirubin, serum levels of ferritin, Iron and T.I.B.C., serum level of malondialdehyde and serum levels of ceruloplasmin and transferrin.Regarding to our results, serum level of total bilirubin showed statistically highly significant decrease after exchange transfusion [E.T.] and primary antioxidant [ceruloplasmin and transferrin] were significantly elevated after E.T. As regard pro oxidants, there was highly significant decrease in serum levels of ferritin, iron and malondialdehyde after E.T. and highly significant rise in serum level of T.I.B.C. after E.T. The differences between the mean values of serum ferritin, iron, T.I.B.C., transferrin and - ceruloplasmin before and after exchange transfusion were statistically significant in preterm and neonates with birth weight less than 2kg. Transferrin showed positive correlation with gestational age.After exchange transfusion there was significant decrease in serum levels of ferritin and iron and significant increase in T.I.B.C. in both groups of neonataI hyperbilirubinemia and neonatal hyperbilirubinemia with septicemia. Serum levels of transferrin and ceruloplasmin were also increased after exchange transfusion in both groups but without significant statistical difference. Finally we can conclude that elevation of serum levels of primary antioxidants [ceruloplasmin and transferrin] and lowering serum levels of oxygen free radicals [MDA as an index] after exchange transfusion indicate its important role not only in decreasing the serum bilirubin level but also in improving the defence mechanism against oxygen free radical injury especially in preterm neonates. Preterm and neonates with low birth weight are more vulnerable to neonatal oxygen radical diseases because of their developmentally low iron associated antioxidant proteins [transferrin]