Chapter 10 - NICU transfusion guidelines and strategies to minimize transfusions

Abstract

Pathologic anemia is defined by a red blood cell mass inadequate to meet the oxygen needs of tissues. Neonates often require red cell transfusions due to a decreased red cell mass brought about by acute blood loss. Preterm infants frequently experience a decline in red cell mass due to phlebotomy, a shortened red cell lifespan, and lack of erythropoietic response to a dropping hematocrit due to lack of erythropoietin (Epo) production, termed the anemia of prematurity. Target hemoglobin and hematocrit have been used as an indicator for a red cell transfusion in preterm neonates. Recently published data from two large multicentered trials in Europe and the United States showed that a restrictive approach (using a lower hematocrit to trigger a transfusion) resulted in fewer transfusions without an increase in death or serious neurodevelopmental impairment. The identification of individualized markers for transfusion need, beyond hematocrit triggers, that optimally balance the risk and benefits of transfusion, coupled with strategies to increase red cell mass to minimize transfusions, will serve to improve “transfusion stewardship,” the appropriate and judicious use of transfusions in the NICU.