First report of transfusing low‐titer cold‐stored type O whole blood to an extremely‐low‐birth‐weight neonate after acute blood loss

Abstract

Background: Multiple reports suggest that cold-stored low-titer type O whole blood (LTOWB) is becoming a preferred transfusion product for resuscitating massive hemorrhage across trauma, obstetrical, and pediatric services. However, we know of no reports of using this product for emergency transfusion of newborn infants after acute severe hemorrhage.Case Report: We report our experience with emergency transfusion of rewarmed LTOWB using a fluid warmer for the resuscitation of a hypotensive 25-week gestation neonate following acute and severe placental abruption.The transfusion was tolerated well, without evidence of hemolysis or other complications.Conclusions: This is the first report of which we are aware of transfusing warmed LTOWB to a preterm neonate. Our positive experience leads us to speculate that this product could have a role for neonates following acute severe blood loss.

Neonatal subgaleal hemorrhage: twenty years of trends in incidence, associations, and outcomes

“…Our healthcare system recently approved incorporating LTOWB for emergency release blood transfusion of neonates, as an alternative to component transfusions in the setting of acute severe blood loss [23]. This protocol, which we have used successfully in extremely low gestational age newborns [25], supports the hypothesis that emergency transfusion of LTOWB could reduce total volume transfused and potentially improve outcomes.…”

“…We see four potential treatment advances that we had yet not organized into a "severe SH treatment pathway". As listed in Table 5 these include: 1) recombinant activated Factor VII to facilitate hemostasis [17,18]; 2) tranexamic acid (TXA) to facilitate thrombus stabilization [19][20][21]; and 3) transfusing hemorrhaging neonates through a blood warmer system with low-titer, cold-stored, type O whole blood (LTOWB) [22][23][24][25], as opposed to the serial non-warmed component transfusions we have been using; and 4) stimulating red cell production using darbepoetin. Recent advances in mass transfusion for pediatric hemorrhagic shock have include the bene t of LTOWB transfusion.…”

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

“…1 In addition to that recommendation, at Intermountain Health we request that a hemoglobin measurement be obtained with every umbilical cord gas, as a means of rapidly identifying anemia at birth, among these high-risk neonates. [2][3][4] We were uncertain how frequently both an umbilical arterial and a venous blood gas, each with a hemoglobin level, are successfully being drawn and reported at our high-risk deliveries. In actual practice, the implementation of recommendations is virtually always incomplete, because barriers to full implementation exist.…”