Blood and Blood Component Therapy in Neonates

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AIIMS- NICU protocols 2008

Blood and blood component therapy in neonates

Authors: Richa Jain, Senior Resident Bipin Jose, Junior Resident Poonam Coshic*, Blood Transfusion Officer Ramesh Agarwal, Assistant Professor Ashok K Deorari, Profesoor

Department: Division of Neonatology, Department of Pediatrics * Department of Transfusion Medicine All India Institute of Medical Sciences, New Delhi

Corresponding author: Dr Ramesh Agarwal Assistant Professor Division of Neonatology, Department of Pediatrics All India Institute of Medical Sciences, New Delhi Email:

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AIIMS- NICU protocols 2008 ABSTRACT Blood component therapy is a very common intervention practiced in newborns; nearly 85% of extremely low birth weight (ELBW) babies get transfusions during their hospital stay. However, there are no set guidelines for transfusion of blood component therapy in newborns. This protocol includes available types of blood components , their methods of preparation, indications and side effects of transfusion, in relation to newborns. Keywords: Transfusion, packed red cells, platelets, newborn

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AIIMS- NICU protocols 2008 INTRODUCTION Blood components used in modern day practice include, apart from whole blood, a variety of other products, like red blood cell components, platelet concentrates, and plasma. Blood component transfusion has been considered to be a safe and low risk procedure. In the last few decades there has been recognition of hazards of transfusion of blood and its products. It is no longer considered to be a low or no risk procedure, and consequently an increasing need for stricter guidelines for transfusing blood products has been recognized, not just to check infections, but also to minimize other side effects of transfusion. Preterm neonates comprise the most heavily transfused group of patients, and about 85% of extremely low birth weight newborns receive a transfusion by the end of their hospital stay.1,2 RED BLOOD CELL PRODUCTS Red cells and their products include packed red blood cells (PRBCs) and modified blood products used for specific situations including: 1. Leukocyte reduced RBCs 2. Irradiated RBCs 3. Washed RBCs 4. RBCs with low CMV risk Indications for PRBC transfusion in neonatal practice PRBCs are the most commonly used blood product in neonatal transfusions.3 Indications for transfusion of PRBCs are mainly resolution of symptomatic anemia and for improvement of tissue oxygenation. Tissue oxygenation depends on cardiac output, oxygen saturation and hemoglobin concentration. Once cardiac output and oxygen saturation are optimal, tissue oxygenation can only be improved by increasing the hemoglobin level. The guidelines for transfusion of PRBC vary according to age, level of sickness and hematocrit (Table 1).3 Table 1: Guidelines for packed red blood transfusion thresholds for preterm neonates3 cells (PRBCs)

Less than 28 days of age and 1. Assisted ventilation with FiO2 more than 0.3: Hb 12.0 gm/dL or PCV less than 40% 2. Assisted ventilation with FiO2 less than 0.3: Hb 11.0 g/dL or PCV less than 35% 3. CPAP: Hb less than 10 gm/dL or PCV less than 30% More than 28 days of age and 1. Assisted ventilation: Hb less than 10 gm/dL or PCV less than 30% 2. CPAP: Hb less than 8 gm/dL or PCV less than 25% Downloaded from 3

AIIMS- NICU protocols 2008

Any age, breathing spontaneously and 1. On FiO2more than 0.21: Hb less than 8 gm/dL or PCV less than 25% 2. On Room Air: Hb less than 7 gm/dL or PCV less than 20%

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AIIMS- NICU protocols 2008 Packed Red Blood Cells (PRBCs) Most RBC components available today are derived from the collection of 350 to 450 mL of whole blood into sterile plastic bags containing citrate-phosphate-dextrose (CPD) anticoagulant. The whole blood is spun to sediment out the RBCs, and most of the plasma...
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