Current practice in neonatal exchange transfusions: a retrospective audit based at one transfusion centre

Abstract

As a result of the widespread use of phototherapy, the need for neonatal exchange transfusion has declined markedly over the last 25 years. However, in spite of this, we have discovered a marked disparity in the number of requests for units of blood suitable for exchange transfusion made by neonatal units of similar size. A retrospective audit was therefore performed to establish current practice. A questionnaire was sent to consultant neonatologists and an audit trail of all units of blood issued from our Transfusion Centre for exchange transfusion over an 18-month period was followed. A significant finding was the large amount of overordering of blood by neonatologists, resulting in units produced expensively to high specification being given to other patients. Only 42% of the blood issued for exchange transfusions was actually used for that purpose. Also, published guidelines are not being adhered to, particularly with respect to the specification of the blood products being used. Better communication between neonatologists, hospital haematologists and transfusion medicine specialists would help to ensure that infants requiring exchange transfusion are given the best product and that valuable resources are not wasted.

Fetal, neonatal and paediatric transfusion medicine

“…Blood for ET is compatible with mother and child, in general O‐D agt neg ,C,E,K negative or R1R1, K negative, leucoreduced and stored less than 5 days because of 2,3 BPG. According to guidelines, either whole blood from donors lacking high titre anti‐A and anti‐B and irregular red cell antibodies or reconstituted red cells with AB citrate plasma (FFP, also lacking irregular RBC antibodies), can be used [10,11]. Male (plasma) donors lacking leucocyte antibodies are preferred.…”

Paediatric transfusion

“…For IUTs, a higher haematocrit is used in order to minimize the number of procedures needed by maximizing the red cell volume transfused. For neonatal exchange transfusions, there is a lack of consensus over the optimal product and haematocrit, with some neonatologists preferring to use whole blood [39,40]. The BCSH guidelines [34] recommend the use of red cells with a more tightly regulated haematocrit, 0·5–0·6, in order to generate an acceptable postexchange haemoglobin (Hb) level.…”