Hazards of Neonatal Blood Transfusion

Abstract

After completing this article, readers should be able to: 1. Describe acute immune-mediated transfusion reactions seen in neonates, their treatment, and their prevention. 2. Describe acute nonimmune-mediated transfusion reactions seen in neonates, their treatment, and their prevention. 3. Describe delayed transfusion complications. 4. Delineate the steps involved in the blood donor screening process in the United States. The safest blood transfusion is the one not administered. When a transfusion is needed, it is important for both physicians and nursing staff to be aware of its potential acute and delayed adverse effects. Adverse consequences may be minimized through early recognition and prompt therapeutic intervention. Noninfectious complications may be either acute (occurring within hours of transfusion) or delayed. Acute reactions may be categorized further according to their pathogenesis: immunologic versus nonimmunologic. Patients should be monitored closely during the transfusion. For all suspected transfusion reactions, the ordering physician and the nursing staff should be trained to stop the transfusion immediately, keep the intravenous line open, check that the blood component was given to the correct patient, and assess and treat symptoms. A posttransfusion blood specimen and the blood bags should be sent to the Transfusion Service (TS) along with a transfusion reaction report form that includes patient diagnosis, history of previous reactions, date and time of reaction with associated symptoms, and vital signs before and after the transfusion. The TS technologist performs a clerical check, inspects posttransfusion blood samples for hemolysis, and repeats ABO/Rh testing on both the transfused unit and the patient’s sample along with a direct antiglobulin (Coombs) test. Further testing is guided by the nature of the patient’s symptoms. Suspected delayed complications of transfusion also should be reported to the TS so the appropriate investigation may be initiated. ### Acute Immune-mediated Transfusion Reactions Acute hemolytic transfusion reactions are the second most common cause of transfusion-related fatality in adult patients, …