Neonatal and Pediatric Transfusion Practice

Question 1

what is considered the neonatal period?

Answer 1

up to 4 months of age

Question 2

why are neonates so heavily transfused?

Answer 2

size
blood volume
physiologic anemia (normal decline in Hgb)
iatrogenic blood loss

Question 3

what causes normal decline in Hgb concentration after birth?

Answer 3

decrease erythropoietin
decrease in fetal red cell survival
increase in blood volume due to rapid growth

Question 4

main oxygen transport protein for fetus during last 7 months of development in the uterus

Answer 4

fetal hemoglobin

Question 5

which has higher oxygen affinity - Hgb A or Hgb F?

Answer 5

Hgb F

Question 6

% of infant’s hemoglobin that is Hgb F

Answer 6

50-95%

Question 7

when does fetal Hgb percentage decline?

Answer 7

after 6 months

Question 8

pathophysiology of neonatal anemia

Answer 8

diminished EPO output in response to anemia

Question 9

what causes diminished EPO output in response to anemia?

Answer 9

inadequate production of EPO

increased clearance or volume of distribution of this hormone in neonates relative to adults

Question 10

neonatal complications that may require transfusion

Answer 10

bleeding/coagulopathy
hypotension/hypovolemia
infection
necrotizing enterocolitis
hyerpbilirubinemia
surgery

Question 11

what causes T-activation associated with neonatal necrotizing enterocolitis?

Answer 11

bacteria release sialidases that cleave sialic acid residues creating neoantigens - naturally occurring complement dependent antibodies cause lysis of neoantigen labeled red cells

Question 12

common transfusion guidelines for neonates with severe cardiopulmonary disease

Answer 12

Hct 40%

Question 13

common transfusion guidelines for neonates with moderate cardiopulmonary disease and for major surgery

Answer 13

30%

Question 14

common transfusion guidelines for neonates with symptomatic anemia

Answer 14

25%

Question 15

component for neonatal red cell transfusion

Answer 15

group O, ABO identical, or ABO compatible
Rh negative or Rh pos to Rh pos
CMV negative or leukocyte reduced

Question 16

10 mL of CPDA packed red cells per kg of will raise neonate Hgb by?

Answer 16

3 g/dl

Question 17

10 mL of AS packed red cells per kg of body weight will raise neonate’s hgb by what?

Answer 17

2 g/dl

Question 18

dosing of red cell units with additive solutions should not exceed ___ ml/kg for neonates?

Answer 18

10-15

Question 19

why is fresh (<5-7 days) preferred by many neonatology groups?

Answer 19

hyperkalemia
shortened RBC life
hyperglycemia
hypernatremia
renal toxicity
acidosis
increased oxyhemoglobin affinity

Question 20

causes of neonatal thrombocytopenia

Answer 20

impaired production
increased destruction
abnormal distribution
dilution due to massive transfusion

Question 21

indications for neonatal platelet transfusion

Answer 21

<50,000/ul with active bleeding

prophylactically for low counts before invasive procedure

Question 22

5-10 mg/kg body weight will raise platelet count of neonate by?

Answer 22

50,000-100,000/ul

Question 23

ABO requirement for neonatal platelet transfusion?

Answer 23

ABO plasma specific/compatible

Question 24

neonatal plasma transfusion indications

Answer 24

hemorrhagic disease of the newborn with significant bleeding
baby with coagulopathy bleeding
baby with coagulopathy about to have invasive procedure

Question 25

most common acquired coagulopathies in neonates

Answer 25

vitamin K deficiency
DIC
liver dysfunction

Question 26

causes of fetal/neonatal DIC

Answer 26

hypoxia-acidosis
sepsis
NEC
meconium aspiration
hemolysis
protein C and/or protein S deficiency

Question 27

neonatal plasma dose for transfusion

Answer 27

15 ml/kg over 150-30 minutes

Question 28

vitamin K dependent factors

Answer 28

factor II, VII, IX, X

Question 29

dose of granulocytes for neonatal transfusion

Answer 29

10-15 ml/kg body weight

Question 30

why are children with thalassemia syndromes given routine RBC transfusions?

Answer 30

prevent tissue hypoxia and suppress endogenous erythropoiesis in order to support more normal growth and development

Question 31

why are children with sickle cell disease frequently transfused?

Answer 31

lower the concentration of red cells containing Hgb S and suppress production of Hgb S

Question 32

why are blood warmers recommended for neonates?

Answer 32

neonates are susceptible to cold stress