Neonatal and Pediatric Transfusion Practice Flashcards
what is considered the neonatal period?
up to 4 months of age
why are neonates so heavily transfused?
size
blood volume
physiologic anemia (normal decline in Hgb)
iatrogenic blood loss
what causes normal decline in Hgb concentration after birth?
decrease erythropoietin
decrease in fetal red cell survival
increase in blood volume due to rapid growth
main oxygen transport protein for fetus during last 7 months of development in the uterus
fetal hemoglobin
which has higher oxygen affinity - Hgb A or Hgb F?
Hgb F
% of infant’s hemoglobin that is Hgb F
50-95%
when does fetal Hgb percentage decline?
after 6 months
pathophysiology of neonatal anemia
diminished EPO output in response to anemia
what causes diminished EPO output in response to anemia?
inadequate production of EPO
increased clearance or volume of distribution of this hormone in neonates relative to adults
neonatal complications that may require transfusion
bleeding/coagulopathy hypotension/hypovolemia infection necrotizing enterocolitis hyerpbilirubinemia surgery
what causes T-activation associated with neonatal necrotizing enterocolitis?
bacteria release sialidases that cleave sialic acid residues creating neoantigens - naturally occurring complement dependent antibodies cause lysis of neoantigen labeled red cells
common transfusion guidelines for neonates with severe cardiopulmonary disease
Hct 40%
common transfusion guidelines for neonates with moderate cardiopulmonary disease and for major surgery
30%
common transfusion guidelines for neonates with symptomatic anemia
25%
component for neonatal red cell transfusion
group O, ABO identical, or ABO compatible
Rh negative or Rh pos to Rh pos
CMV negative or leukocyte reduced
10 mL of CPDA packed red cells per kg of will raise neonate Hgb by?
3 g/dl
10 mL of AS packed red cells per kg of body weight will raise neonate’s hgb by what?
2 g/dl
dosing of red cell units with additive solutions should not exceed ___ ml/kg for neonates?
10-15
why is fresh (<5-7 days) preferred by many neonatology groups?
hyperkalemia shortened RBC life hyperglycemia hypernatremia renal toxicity acidosis increased oxyhemoglobin affinity
causes of neonatal thrombocytopenia
impaired production
increased destruction
abnormal distribution
dilution due to massive transfusion
indications for neonatal platelet transfusion
<50,000/ul with active bleeding
prophylactically for low counts before invasive procedure
5-10 mg/kg body weight will raise platelet count of neonate by?
50,000-100,000/ul
ABO requirement for neonatal platelet transfusion?
ABO plasma specific/compatible
neonatal plasma transfusion indications
hemorrhagic disease of the newborn with significant bleeding
baby with coagulopathy bleeding
baby with coagulopathy about to have invasive procedure
most common acquired coagulopathies in neonates
vitamin K deficiency
DIC
liver dysfunction
causes of fetal/neonatal DIC
hypoxia-acidosis sepsis NEC meconium aspiration hemolysis protein C and/or protein S deficiency
neonatal plasma dose for transfusion
15 ml/kg over 150-30 minutes
vitamin K dependent factors
factor II, VII, IX, X
dose of granulocytes for neonatal transfusion
10-15 ml/kg body weight
why are children with thalassemia syndromes given routine RBC transfusions?
prevent tissue hypoxia and suppress endogenous erythropoiesis in order to support more normal growth and development
why are children with sickle cell disease frequently transfused?
lower the concentration of red cells containing Hgb S and suppress production of Hgb S
why are blood warmers recommended for neonates?
neonates are susceptible to cold stress
