Role of serum ischemia-modified albumin in guiding red blood cell transfusion decisions in preterm neonatal anemia

Background Anemia in preterm neonates is a prevalent condition managed primarily through red blood cell transfusions guided by hemoglobin thresholds. However, hemoglobin may not accurately reflect tissue oxygenation, potentially leading to suboptimal transfusion decisions. Objective To evaluate ischemia-modified albumin (IMA) as a biomarker for guiding transfusion decisions in anemic preterm neonates. Patients and methods In a prospective case–control study, 72 preterm neonates (≤34 weeks gestation) with anemia were divided into transfusion (cases N =36) and nontransfusion (control N =36) groups, matched by gestational age and sex. Serum IMA, hemoglobin, and hematocrit were measured pretransfusion and posttransfusion in the case group, and once at enrollment in controls. Clinical outcomes and hematologic parameters were compared. Receiver-operating characteristic analysis assessed IMA’s diagnostic accuracy. Results Hemoglobin and hematocrit levels did not significantly differ between groups. However, IMA was significantly higher in the transfused group (median: 237.25 vs. 44.98 ng/ml; P <0.001) and decreased notably after transfusion (median: 17.1 ng/ml). Clinical symptoms improved posttransfusion. Receiver-operating characteristic analysis showed an IMA more than 102.5 ng/ml predicted the need for transfusion with 100% sensitivity and specificity. Conclusion IMA is a sensitive, real-time marker of tissue hypoxia and may enhance transfusion decisions in preterm neonates beyond hemoglobin-based criteria.