Current Issues in Neonatal Transfusions

Strauss, Ronald G.

doi:10.1159/000461444

Cited by 8 publications

(7 citation statements)

References 27 publications

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“…Limited donor program has been a matter of interest[ 1 ] for the pediatrician as well as TM specialists for a long time. The main driving forces for these programs were the primarily appropriate use of blood in patients of pediatric age group.…”

Section: Discussionmentioning

confidence: 99%

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Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients

Arora

Marwaha

Dhawan

et al. 2017

Asian J Transfus Sci

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BACKGROUND:Many strategies have been explored to reduce multiple donor exposures in neonates such as use of restrictive transfusion protocols, limiting iatrogenic blood loss, use of recombinant erythropoietin and single donor programs.METHOD:In our study we assessed the feasibility of dedicating single donor units with reserving all the components from the same donor for the specified neonates/infants undergoing surgery and estimating reduction of donor exposure. Fifty neonates undergoing surgery were included in the prospective study group and the transfusion details were compared with 50 retrospective cases with same inclusion criteria.RESULTS:An intra-operative blood loss of >13 ml/Kg was significantly associated with transfusion (P <0.05) which was most frequently administered in the intra-operative period. Donor exposure rate of overall transfusion was 1.15 in the study group as compared to 4.03 in the retrospective control group. In study group Donor Exposure Rate (DER): Transfusion Rate (TR) ratio was 1:1.5 and Transfusion per Donor Unit (TPDU) of 1.5, means that one donor unit contributed to 1.5 transfusions in each patient and contributed to 50% reduction in donor exposure in each patient as compared to retrospective control group.CONCLUSION:Our study showed that by practicing dedicated donor unit transfusion policy, for neonates undergoing surgery we could significantly reduce the donor exposure.

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Section: Discussionmentioning

confidence: 99%

“…During the first few weeks of neonatal life, there is a physiological decrease in red cells. In healthy term infants, the nadir blood hemoglobin generally does not fall below 9 g/dl at 10–12-week old,[ 1 ] this decline is well tolerated by term infants. In preterm infants, the decline occurs earlier and it is more pronounced.…”

Section: Introductionmentioning

confidence: 99%

Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients

Arora

Marwaha

Dhawan

et al. 2017

Asian J Transfus Sci

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“…Studies has proven that multiple RBC transfusions during the first weeks of life was new born infants, especially for those premature ones with birth weight less than 1.3 Kg. 1 Severe respiratory or cardiac diseases has predisposed infants to repeated blood sampling and consequent replacement transfusions During the first 2-3 weeks of life. 2 The haematopoietic system a preterm infant is incompletely developed and poorly adapted to serve the foetus.…”

Section: Discussionmentioning

confidence: 99%

“…This further may lead to additional transfusions. 1 Due physiological factors a decline in circulating RBC volume will be there in first few weeks of infant life. 4 Additionally blood losses due to phlebotomy can lead to anaemia.…”

Section: Discussionmentioning

confidence: 99%

Transfusion Requirements of Sick Neonates in Intensive Care Unit

Viswanathan¹,

Vilambil²,

Usha³

2019

jemds

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BACKGROUND Eighty five percent of babies admitted to hospital care with extremely low birth weight is receiving some type of blood component transfusion. In such a scenario, if the frequency of transfusion is reduced, the associated donor exposure and adverse reactions can be decreased. Risk based estimation of blood usage can identify those infants who are likely to require transfusion. We wanted to describe usage pattern of blood and blood components in the intensive care unit of a speciality centre. METHODSThe research was descriptive type in nature. The study was performed on neonates with a gestational age less than 37 weeks and/or a birth weight of less than 2500 grams admitted to the Neonatal Intensive Care Unit (NICU) of Sri Avittom Thirunal Hospital (SATH), Government Medical College, Thiruvananthapuram. The sample size was 150. Demographic characteristics and details of transfusion related to mother and baby were collected. SPSS software version 16 was used for statistical analysis. RESULTSAmong study subjects, 23.3% required one unit of red cells, 36% required two units of PRC, 35.3% required three units and 5.3% required four units during their hospital stay. Among FFP transfused babies, 17.4% received one unit, 32.6% received two units, 34.9% received three units and 15.1% received four units during their hospital stay. On analysis, 42.7% of the neonates received red cells alone and 57.3% of the neonates received both red cells and Fresh Frozen Plasma (FFP). On analysing the usage of platelet concentrate among neonates, 34.6% received one unit of platelet concentrate, 48.1% received two units and 17.3% received three units during their hospital stay. On assessment, 34.7% received platelet concentrate along with red cells while the rest 65.3% received red cells only. CONCLUSIONSMultiple transfusions were common among neonates. Majority of infants received multiple components too.

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“…During the first weeks of life, all infants experience a decline in the number of circulating RBCs. In healthy term infants, the nadir blood hemoglobin (Hb) value rarely decreases to less than 9 g per dL (mean, 11‐12 g/dL) at an age of approximately 10 to 12 weeks 1 . Because this postnatal decrease in Hb level is universal and is well tolerated by term infants, it is commonly called the physiologic anemia of infancy.…”

Section: Pathophysiology Of Anemia Of Prematuritymentioning

confidence: 99%

How I transfuse red blood cells and platelets to infants with the anemia and thrombocytopenia of prematurity

Strauss

2008

Transfusion

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Many aspects of hematopoiesis are either incompletely developed in preterm infants or still functioning to serve the fetus (i.e., the intrauterine counterpart to a liveborn preterm neonate). This delayed development and/or slow adaptation to extrauterine life diminishes the capacity of the neonate to produce red blood cells (RBCs), platelets (PLTs), and neutrophils-particularly during the stress of life-threatening illnesses encountered after preterm birth such as sepsis, severe pulmonary dysfunction, necrotizing enterocolitis, and immune cytopenias. The serious medical and/ or surgical problems of preterm birth can be further complicated by phlebotomy blood losses, bleeding, hemolysis, and consumptive coagulopathy. To illustrate, some preterm infants, especially those with birth weight less than 1.0 kg and respiratory distress, are given numerous RBC transfusions early in life owing to several interacting factors. Neonates delivered before 28 weeks of gestation (birth weight, <1.0 kg) are born before the bulk of iron transport has occurred from mother to fetus via the placenta and before the onset of marked erythropoietic activity of fetal marrow during the third trimester. Soon after preterm birth, severe respiratory disease can lead to repeated blood sampling for laboratory studies and, consequently, to replacement RBC transfusions. Additionally, preterm infants are unable to mount an effective erythropoietin (EPO) response to decreasing numbers of RBCs, and this factor contributes to the diminished ability to compensate for anemiathus enhancing need for RBC transfusions. PATHOPHYSIOLOGY OF ANEMIA OF PREMATURITYDuring the first weeks of life, all infants experience a decline in the number of circulating RBCs. In healthy term infants, the nadir blood hemoglobin (Hb) value rarely decreases to less than 9 g per dL (mean, 11-12 g/dL) at an age of approximately 10 to 12 weeks. 1 Because this postnatal decrease in Hb level is universal and is well tolerated by term infants, it is commonly called the physiologic anemia of infancy. Among preterm infants, this decline occurs at an earlier age and is more pronounced in severity. Mean Hb concentration decreases to approximately 8 g per dL in infants of 1.0 to 1.5 kg birth weight and to 7 g per dL in infants weighing less than 1.0 kg.2 This marked decline in Hb frequently is exacerbated by phlebotomy blood losses and may be associated with symptomatic anemia that necessitates RBC transfusions-making the anemia of prematurity an illness rather than a "physiologic" event.Physiologic factors that influence erythropoiesis and the biologic characteristics of EPO are critical in the pathogenesis of the anemia of prematurity. Growth is extremely rapid during the first weeks of life, and RBC production by neonatal marrow must increase commensurately to avoid a decreasing hematocrit (Hct) caused by an insufficient number of circulating RBCs being diluted within the expanding blood volume. It is widely accepted that the circulating life

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Current Issues in Neonatal Transfusions

Cited by 8 publications

References 27 publications

Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients

Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients

Transfusion Requirements of Sick Neonates in Intensive Care Unit

How I transfuse red blood cells and platelets to infants with the anemia and thrombocytopenia of prematurity

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