Red Blood Cell Transfusion and Risk of Iron Overload in Preterm Infants: A Prospective Study on Serum Ferritin and Hepcidin

Introduction: The aims of this study were to evaluate iron metabolism changes and overload risk in preterm infants after red blood cell transfusion (RBCT) and to assess hepcidin's diagnostic value. METHODS: This prospective study analyzed 72 preterm infants (mean GA: 30.1 weeks; BW: 1,356 g) at Shenzhen Children's Hospital (2023). Groups were stratified by the volume of RBCT (>40 mL/kg vs. ≤40 mL/kg). Serum ferritin (SF) and hepcidin levels were measured alongside clinical parameters. RESULTS: The >40 mL/kg RBCT group had significantly lower GA (p = 0.039) and BW (p = 0.013). SF and hepcidin levels were elevated in the >40 mL/kg RBCT group (p < 0.001), with higher risks of iron overload (RR = 1.6, 95% CI: 1.3-2.3) and severe overload (RR = 4.5, 95% CI: 1.8-12.4). The volume of RBCT was an independent risk factor (p = 0.034). Hepcidin showed predictive value (area under the curve = 0.731, sensitivity: 92%, cutoff: 45.08 ng/mL). CONCLUSIONS: High-volume of RBCT (>40 mL/kg) significantly increase iron overload risk in preterm infants. Hepcidin demonstrates potential as a predictive biomarker. .