Data‐driven blood banking practices for neonatal RBC transfusions

Strauss, Ronald G.

doi:10.1046/j.1537-2995.2000.40121528.x

Cited by 107 publications

(98 citation statements)

References 101 publications

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“…Many recent studies have reported benefits of instituting written transfusion guidelines for NICU patients. [8][9][10][11][12][13] However, much additional study is needed to provide data upon which to base NICU transfusion guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Identifying and eliminating any unnecessary transfusions in the NICU would be a step toward better care, lower costs and more careful preservation of blood component resources. 8,9 Establishing NICU transfusion guidelines has been advocated as a way to improve transfusion practice and reduce unnecessary transfusions. [8][9][10][11][12][13] In 2002, Intermountain Healthcare, a not-forprofit healthcare organization in the western United States, established a written set of NICU transfusion guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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Objective: We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of noncompliance that could be addressed by quality improvement measures. Result: During 2006 the three NICUs cared for 1759 neonates. Seventeen percent of these received one or more (median 3) erythrocyte transfusions, 4% received one or more (median 3) platelet transfusions, 6% received one or more (median 1) FP infusions and 2% received cryoprecipitate (median 1 dose). Seventy percent of the erythrocyte transfusions were given in compliance with the guidelines, as were 69% of the platelet transfusions, 65% of the FP transfusions and 94% of the cryoprecipitate administrations. Patients who received large numbers of transfusions were more likely to receive transfusion that violated the guidelines. Forty-five percent of patients who received 1 to 3 transfusions received all transfusions within guidelines. However, only 18% of patients who received 4 to 10 transfusions received all within guidelines. No patient who received >10 transfusions received all within the guidelines. Erythrocyte transfusions given early in the hospital course were likely to be within guidelines; 72% (588/818) in the first 29 days were compliant with guidelines, but compliance fell to 61% (144/237) for transfusions administered after 29 days (P ¼ 0.002). About half of the platelet transfusions given early in the hospital course were in violation of guidelines, but after day 9, 83% of platelet transfusions were compliant with guidelines (P ¼ 0.000). Conclusion:Opportunities exist in our healthcare system to improve compliance with our transfusion guidelines. Such opportunities are greatest among neonates receiving multiple transfusions, among those receiving erythrocyte transfusions late in their NICU course and among those receiving platelet transfusions early in their NICU course.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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“…In addition, by the time the red cells are irradiated they may have been stored for up to 2 weeks allowing lactate levels to increase due to anaerobic energy metabolism in the erythrocytes [4]. Several studies have reported extremely high levels of K + along with increased lactate concentrations in units of IRC [1,3,5,6]. This has the potential to lead to complications during and after transfusion.…”

Section: Introductionmentioning

confidence: 99%

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Swindell

Barker

McGuirk

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Objective: High concentrations of potassium and lactate in irradiated red cells transfused during cardiopulmonary bypass may have detrimental effects on infants and neonates undergoing cardiac surgery. The effects of receiving washed and unwashed irradiated red cells from the cardiopulmonary circuit on serum potassium and lactate concentrations were compared. Methods: The study population included neonates and infants undergoing heart surgery for complex congenital heart disease. A control group (n = 11) received unwashed irradiated red cells and the study group (n = 11) received irradiated red cells washed in a cell saver (Dideco Electa) using 900 ml of 0.9% saline prior to pump priming. Potassium and lactate concentrations were compared before, during and after bypass. Results: Washing irradiated red cells reduced donor blood [potassium] from > 20 to 0.8 AE 0.1 mmol/l, and [lactate] from 13.7 AE 0.5 to 5.0 AE 0.3 mmol/l ( p < 0.001). The resulting prime had significantly lower [potassium] and [lactate] than the unwashed group (potassium 2.6 AE 0.1 vs 8.1 AE 0.4 mmol/l, p < 0.001; lactate 2.6 AE 0.2 vs 4.6 AE 0.3 mmol/l, p < 0.001). Peak [potassium] in the unwashed group occurred 3 minutes after going on bypass (4.9 AE 0.3 mmol/l) and during rewarming (4.9 AE 0.4 mmol/l). These were significantly higher than the washed group (3.1 AE 0.1, p < 0.001 and 3.0 AE 0.1 mmol/l, p < 0.001). The [potassium] was greater than 6.0 mmol/l for 4 out of these 11 unwashed patients compared with none of the washed group. Immediately postbypass the washed group had significantly lower serum [potassium] (3.2 AE 0.1 vs 4.2 AE 0.2 mmol/l, p = 0.002). There was no significant difference in [lactate] between groups during and after cardiopulmonary bypass. Conclusions: The washing of irradiated red cells reduces potassium and lactate loads and prevents hyperkalaemia during cardiopulmonary bypass. The washing of irradiated red cells should be considered in neonates and infants undergoing cardiac surgery for complex congenital heart disease. #

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“…20 In contrast, late transfusions, those given after the first or second week, are generally ordered because of a falling hemoglobin associated with the normocytic, normochromic, hyporegenerative anemia termed the anemia of prematurity. 21,22 Early and late RBC transfusions might each provide certain benefits to VLBW neonates, but both carry risks. Because of known and unknown risks, any successful efforts to eliminate unneeded transfusions could improve patient outcomes, conserve valuable blood-bank resources and reduce intensive care costs.…”

Section: Discussionmentioning

confidence: 99%

Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?

et al. 2011

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Objective: Red blood cell (RBC) transfusions can suppress erythropoiesis. On this basis, RBC transfusions administered to very low birth weight (VLBW) neonates potentially render them more likely to qualify for a subsequent transfusion.Study Design: We hypothesized that 'late' (>14 days after birth) RBC transfusions given to VLBW neonates result in a decrease in reticulocyte count persisting for at least 7 to 10 days. We also hypothesized that a single dose of darbepoetin given along with the transfusion would have the opposite effect, increasing the reticulocyte count for at least 7 to 10 days. To test this, we conducted a single-centered randomized trial with 20 VLBW neonates who, according to our transfusion guidelines, qualified for a late transfusion.Result: VLBW infants about to receive a late RBC transfusion were randomized (1:1) to also receive vs not receive (controls) a single subcutaneous dose of darbepoetin (10 mg kg À1 ). Reticulocyte counts diminished significantly in the controls (a drop of 85±62 Â 10 3 ml À1 (mean ± s.d.) at 7 to 10 days), but increased significantly in the darbepoetin recipients (an increase of 177±120 Â 10 3 ml À1 at 7 to 10 days, P<0.0001). At 7 to 10 days after the transfusion, hematocrits of the controls were 8.1±4.9 points above their pre-transfusion values and of the darbepoetin group were 12.4 ± 2.7 points above their pre-transfusion values (P ¼ 0.033). Conclusion:This was a limited-scope, single-centered, randomized trial intended to pilot-test a new concept in neonatal transfusion practice. Namely, we tested whether a late RBC transfusion suppressed reticulocytosis and whether a concomitant single dose of darbepoetin counteracted that suppression. Using the pilot data presented in this study, larger trials can now be designed to address meaningful clinical outcomes such as transfusion avoidance using this approach.

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Data‐driven blood banking practices for neonatal RBC transfusions

Cited by 107 publications

References 101 publications

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?

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