Minimising blood loss and the need for transfusion in very premature infants Flashcards
What are the risks of drawing blood?
3
Pain
Infection - from skin breakdown
Anemia
What are the risks of PRBC transfusions?
5
acute lung injury graft-versus-host disease increased hospital mortality of VLBW infection transfusion reaction
How can we minimise transfusions for preterm infants?
3
fewer blood sampling
delayed cord clamping - evidence based association with fewer need for transfusions
cord milking - but not enough evidence so it cannot be routine practice. it is faster than delayed cord clamping
Who should get delayed cord clamping?
Everyone
Is there any harm to cord milking stable kids?
No
No higher rates of IVH
Does a lower Hb threshold for transfusion reduce the need for transfusion?
Yes.
Lower reduction in the need for one or more transfusions as well as in donor exposure
Were there any adverse effects of having a lower transfusion threshold?
There was no increased risk of death or serious morbidity at discharge.
There is no clear impact on neurodevelopment outcome. There may be an impact on mild neurocognitive outcomes, but unclear at present.
Should we treat with EPO?
No.
It does decrease the need for transfusion BUT the number of donors may not be reduced and early use of EPO does increase the presence of severe ROP (Number needed to harm 33). Administrating EPO later may lessen the risk of severe ROP
Are there any groups of people in which you would strongly encourage EPO?
Only in those who refuse transfusions
Does early iron supplementation reduce the need for transfusion?
No. Iron within the first 8.5 weeks makes no difference.
Why do we use iron?
We use it because it has been demonstrated to improve haemoglobin and ferritin levels after two months of treatment and reduce the risk of iron deficiency anaemia
Why do we want to prevent iron deficiency anemia
it has been associated with poor cognitive outcomes
When do we start iron?
Once at full feeds
Does ETCO2 correlate well? Are there any populations you would not use it in?
yes
Yes, kids with bad lung disease – there is too much dead space
Does transcutaneous bilirubin monitor correlate with the serum?
Yes
Does non-invasive monitoring reduce the need for transfusion?
Nope. No evidence to support this. We like the thought of it though.
Does point of care testing reduce the need for transfusion?
Yes
Can we use SC continuous glucose monitoring?
It does reduce the need for transfusion, but i s not accurate enough with >10% variability.
Dialysis microcatheters seem to have some promise
Is one type of blood sampling better than another?
Nope. (Art, venous, cap all the same)
How long can you delay cord clamping for?
180s
What are the thresholds for transfusion
Week 1 100
Week 2 85
higher if respiratory support
What volume of blood should you transfuse?
20ml/kg if the respiratory status will permit
