Direct-Push Blood Transfusion Practice in the Neonatal Unit of a Tertiary Hospital in South-South, Nigeria

Abstract

Introduction: Transfusion of blood is a life-saving intervention in the care of ill neonates. Donated blood is a scarce national resource and must be used in the most efficient way. Exchange blood transfusion using the blood bag is the commonest mode of blood delivery employed. Other modalities of safe and sustainable blood delivery should also be explored, especially where paucity of funds predominates. This study aims to assess the usefulness of the direct push method where applicable, as an alternative to blood bag delivery in neonatal units of resource poor settings.
 Methods: A two year retrospective study of newborns admitted in the neonatal wards of the University of Uyo Teaching Hospital. Data obtained were the age, gender, indication for admission, packed cell volume (PCV) before and after transfusion. Blood transfusion was done in aliquots over 24 hours under aseptic conditions, via a peripheral vein. The push and pull method was employed, with no anticoagulant in the syringe. Post-transfusion PCV was done at least 24 hours after the procedure.
 Results: Of the one thousand and seventy-seven (1077) admitted neonates, two hundred and thirty-nine (22.2%), received blood products. Of these, twenty-one (8.8%), received a direct whole blood transfusion. Age (days) of the neonates transfused ranged from 1 to 26 days, with a mean of 10.4 ± 8.13. The Packed Cell Volume (PCV) pre-transfusion ranged between 20% - 44%, with a mean of 30.05 ± 6.39 while post-transfusion PCV ranged between 31% to 51%, with a mean of 38.17 ± 5.52(Fig. 1). The commonest indication for transfusion was prematurity, 9(42.8%) and neonatal sepsis 5 (23.8%).
 Conclusion: The direct transfusion of blood occasionally used, seems a relatively safe practice to correct mild/moderate anaemia. It also provides sufficient blood, with the advantage of usage when the umbilical cord access is no longer feasible and where cost of blood would otherwise, hinder quick intervention. This practice may need further evaluation by other centers.