Blood banking issues pertaining to neonatal red blood cell transfusions

Turkish Neonatal Society guideline on the transfusion principles in newborns

Blood transfusion can be defined as a life-saving procedure in neonates, especially in premature and surgical infants. The indications, threshold hemoglobin, and platelet levels for red cell, platelet, and plasma transfusions in neonates vary among centers and the evidence-based data for possible adverse effects, preterm morbidities, mortality, and neuro-developmental problems associated with transfusions are not clear yet. Herein, we aim to present the transfusion guideline designed to be used in neonatal intensive care units in our country, summarizing clinical findings and threshold levels for red cell, platelet, and plasma transfusions in addition to important practical points of transfusions according to a literature review.

Red blood cell transfusions in newborn infants: Revised guidelines

In general, health care professionals taking care of high risk infants in neonatal intensive care units have become more restrictive in their use of red blood cell transfusion over the past 10 years. The present statement is intended for those caring for high risk newborn infants (preterm to one month of age). The objectives of this statement are to provide guidelines to reduce the incidence of anemia in preterm and term infants, to identify strategies to decrease the need for red blood cell transfusions and to limit donor exposure in this population. Recommendations for red blood cell transfusions are included.

Transfusions of CPDA-1 red blood cells stored for up to 28 days decrease donor exposures in very low-birth-weight premature infants

The goal of this research was to study the safety and the efficacy of transfusing citrate-phosphate-adenine anticoagulant-preservative (CPDA-1) RBC stored for up to 28 days to reduce donor exposures in premature infants. A prospective randomized two-group study was conducted with very low-birth-weight premature infants that received at least one RBC transfusion during hospital stay. Neonates randomly assigned to Group 1 (26 infants) were transfused with CPDA-1 RBC stored for up to 28 days; those assigned to Group 2 (26 infants) received CPDA-1 RBC stored for up to 3 days. Demographic and transfusion-related data were collected. Neonates from both groups showed similar demographics and clinical characteristics. The number of transfusions per infant transfused was 4.4 +/- 4.0 in Group 1 and 4.2 +/- 3.1 in Group 2, and the number of donors per infant transfused was 1.5 +/- 0.8 (Group 1) and 4.3 +/- 3.4 (Group 2), P < 0.001. RBC transfusions containing 29.7 +/- 18.3 mmol L(-1) of potassium (RBC stored for up to 28 days) did not cause clinical or biochemical changes and reduced donor exposures by 70.2%, compared to transfusions containing 19.8 +/- 12.3 mmol L(-1) of potassium (RBC stored for up to 3 days), P < 0.001. In conclusion, RBC stored for up to 28 days safely reduced donor exposures in premature infants.

Blood support for pediatric surgery

Increasingly complicated surgeries are being performed on neonatal and pediatric patients. Provision of a safe and adequate blood supply is essential for the success of many of these surgeries. Depending on the clinical situation, autologous and/or allogeneic blood may be used. However, in all cases, every attempt should be made to minimize the number of donor exposures to reduce the risk of transfusion transmitted infections. Transfusion of neonatal and pediatric patients requires additional considerations too, such as the risk of graft vs host disease, cytomegalovirus infection, the effects of various preservative anticoagulant solutions, electrolyte levels during blood storage, and wheather or not leukoreduced components are indicated.