Abstract
A premature infant on total parenteral nutrition (TPN) with IntralipidR (IL) developed hemolytic anemia with striking stomatocytosis, which cleared when IL was discontinued; 10-month hematologic follow-up has been normal. Another infant on IL also developed hemolytic anemia and stomatocytosis, but expired from complications of prematurity. Ten additional high risk infants on TPN with standard amounts of IL were studied. All developed stomatocytosis. In 9 cases 25% to 50% of RBC's were affected. Stomatocytosis, absent before IL administration, appeared by day 4-7 of IL, peaked at day 5-18, and disappeared 7-10 days after discontinuing IL. One of these infants developed severe hemolytic anemia. Routine transfusions obscured signs of hemolysis in the others. Three infants receiving TPN without IL showed no stomatocytosis; 2 of these developed stomatocytosis when switched to IL. Stomatocytosis is associated with severe abnormalities of RBC membrane composition and function and, occasionally, hemolysis. Also, fetal RBC membranes are different from those of adults. Our findings suggest: (1) IL or its metabolic byproducts interact with newborn RBC's to induce a structural or functional membrane change and may increase susceptibility to hemolysis: (2) Infants on IL should be monitored for signs of hemolysis; (3) An experimental model for the study of membrane physiology is suggested.
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