Blood component therapy during the neonatal period: a national survey of red cell transfusion practice, 1985

Abstract

A questionnaire to determine patterns of neonatal red cell transfusion practice during 1985 was mailed to 2200 blood banks of American Association of Blood Banks (AABB) institutional members and children's hospitals. There were 915 responses (41.6%); 785 responses (86%) contained sufficient data for analysis. The majority (70.6%) of 785 responding hospitals were community/urban institutions. However, more highly specialized, pediatric hospitals were also represented by 92 university/tertiary-care hospitals (11.7% of respondents) and 29 children's hospitals (3.7% of respondents). Two-thirds of hospitals performed a major antiglobulin crossmatch (rather than an abbreviated one) before all neonatal red cell transfusions. The red cell preparation most frequently selected for small-volume transfusions was ABO and Rh group-specific red cell concentrates. When performing only large-volume exchange transfusions, 19.2 percent of hospitals used whole blood; all others prepared reconstituted units of red cells plus fresh-frozen plasma, a practice that frequently causes exposure to two donors per unit. Another practice likely leading to multiple donor exposure is the use of fresh-frozen plasma to adjust the hematocrit of red cell preparations to a predetermined value prior to a small-volume transfusion. Over one-half of hospitals adjusting hematocrits used plasma, presumably from one donor, to dilute packed red cells from another donor, a practice that has no apparent medical benefit. Most hospitals (63.4%) provided red cells with a reduced risk of transmitting cytomegalovirus; blood from seronegative donors was selected by 65 percent of hospitals. The majority of hospitals, including most of the community/urban hospitals, did not irradiate blood products before transfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia, Blood Loss, and Blood Transfusions in North American Children in the Intensive Care Unit

“…After correction for age and illness severity, the increased length of stay and complications shown in the children who received a transfusion provide supportive evidence that efforts at minimizing transfusions should continue. Most data available on incidence of anemia and transfusion practices in the children come from neonates, which do not provide clear guidance for the highly variable PICU population (18)(19)(20). Anemia in critically ill children is almost always treated by blood transfusion, and transfusions have been associated with increased PICU utilization (21).…”

Is There a Role for Autologous/Placental Red Blood Cell Transfusions in the Anemia of Prematurity?

“…Every week in the United States, approximately 10,000 infants are born prematurely (i.e., <37 weeks gestation) with 600 (6%) of these infants being ELBW (1). Approximately 90% of ELBW neonates will receive at least 1 RBC transfusion (2, 3). Physiological and non-physiological factors related to prematurity are responsible for this high transfusion rate, with laboratory blood loss as perhaps the biggest contributor (4).…”

“…Although the known infectious risks of RBC transfusions from each donor exposure are extremely small, and decreasing over time with improvements in donor screening and laboratory infection surveillance, efforts have been made to limit transfusions and consequent donor exposures to the fewest number possible (3, 7, 8). Following this rationale/philosophy to limit exposure to allogeneic donors, it is logical to explore whether some small-volume RBC transfusions, or even all for some infants, might be given as autologous/placental RBCs.…”

Anaemia of prematurity: Pathophysiology and treatment

“…(1) Approximately 90% of ELBW neonates will receive at least one RBC transfusion. (2,3) Physiologic and nonphysiologic factors related to prematurity are responsible for the anaemia of prematurity and this high transfusion rate, with phlebotomy blood loss for laboratory testing as, perhaps, the biggest contributor. (4) Because of efforts to minimize the amounts of blood drawn from neonates for laboratory testing(5) and to transfuse more conservatively (ie, to accept lower pretransfusion hematocrit values), the number of RBC transfusions given to preterm infants has dropped over the years.…”