CHAPTER 44 - Evidence-Based Neonatal Transfusion Guidelines

Abstract

Pathologic anemia is defined by an inadequate red blood cell mass that fails 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 life span, and lack of erythropoietic response to a dropping hematocrit due to lack of erythropoietin 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 multicenter trials in Europe and the United States show that a restrictive approach (using a lower hematocrit to trigger a transfusion) results in fewer transfusions and does not increase the risk of death or serious neurodevelopmental impairment. Individualized markers for transfusion need, beyond hematocrit triggers, that optimally balance the risks and benefits of transfusion continue to be investigated and will serve to improve “transfusion stewardship” (the appropriate and judicious use of red cell transfusions) in the newborn intensive care unit.