Current Practice and Guidelines for the Transfusion of Cellular Blood Components in the Newborn

Abstract

THE FREQUENCY OF blood component transfusions, in particular that of red celI (RBC) concentrates, to premature neonates is amongst the highest of any patient group in tertiary level hospitals. In one study, out of atotai of 4,906 neonates, 120 (2.5%) received bIood transfusions with over two-thirds of those receiving multiple transfusions. 1,3 Infants with birthweights of <1500 g almost invariably receive blood transfusions. 1,2,3 Although the volume of blood transfused to each neonate is smalI, the number of transfusions administered, and consequently the number of donor exposures, is high. In one study, neonates < 1250 g were exposed to a mean of 10.5 donors,3 and in a second study to 8.9 donors. 1 The rate of donor exposures per infant, as reported from several investigators, is presented in Table 1. Concems about transfusion transmitted infectious diseases, including the Human Immunodeficiency virus, have been associated with fewer transfusions (and donor exposures) in adults. However, blood usage and donor exposures continue to be high in neontai intensive care practice. This may reflect the need for aggressive resuscitative measures to saIvage extremely premature infants. CIearly premature neonates are unique. Because of their smalI blood volumes, a major indication for transfusions of RBC concentrates is to replace blood Iost via iatrogenic phIebotomy-bleeding into the lab. 5,6 A concerted effort should be made to reduce donor exposure. Several mechanisms have been suggested, of which the most important are the judicious use of transfusion therapy, the establishment of recognized guidelines for transfusion therapy in the newborn, the implementation of innovative methods to use fewer donors and the further development of laboratory microtechnology.7 In many instances, the need for blood transfusion is unquestioned (eg, exchange transfusion for hyperbilirubinemia and RBC concentrates for anemia that has caused cardiopulmonary compromise). However, in some cases it is apparent that the indications, the associated risks and the optimum blood product for transfusion have not been adequately defined for the neonatal population. 8 ,9,10 This report will review the current