Protocole donneur unique : pratiques transfusionnelles et facteurs de risque des transfusions multiples en réanimation néonatale

Abstract

In France since 2002, the single-donor transfusion protocol, using four pediatric units from the same adult donor's packed red blood cells (PRBCs) in multiply transfused newborns, is recommended in preterm neonates to reduce the risks of infection and alloimmunization. This protocol is controversial, however, because it causes the transfusion of stored blood, which could have adverse consequences. Before the new recommendations of the French Haute Autorité de santé (National authority for health) in 2015, we conducted a national practice survey in 63neonatal intensive care units (NICU) and a retrospective study of the characteristics of 103children transfused within our unit, to better target beneficiaries. The practice survey showed that 30% of French NICUs no longer used the protocol in 2014, due to logistical or financial problems, or concerns about the transfusion of stored blood. The practices were heterogeneous. Few NICUs used a written protocol. In our NICU, the use of single-donor protocol involved the use of units stored for more than 20days in half of the cases beginning with the third unit used. Six-term newborns were mainly transfused once, which does not seem to warrant the single-donor transfusion protocol. The use of this protocol caused the loss of 50% of the manufactured units, which go unused. In multivariate analysis, two factors were predictive of multiple transfusion within our population of 95premature neonates undergoing transfusion: low-term and a high Clinical Risk Index for Babies (CRIB) score. The risk of multiple transfusions would be reduced by about 15% for each additional week of gestation and approximately 16% per point within the CRIB score. These variables integrated into a statistical model predict the risk of multiplying transfusions. According to the ROC curve, a calculated risk higher than 50% is the appropriate cut-off value to transfuse with the single-donor transfusion protocol. This would limit its indications, saving more than 130pediatric units of blood for 100transfused children. A prospective study in our department will allow internal validation of this test.