RBC transfusion in newborn infants

Question 1

What are the most common indications for transfusion PRBC in newborns? (2)

Answer 1

Hemorrhagic shock

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Question 2

How is the blood stored/produced by Canadian blood services?

Answer 2

Buffy coat production method: saline, adenine, glucose, mannitol additive to RBC

Question 3

For how many days is PRBC good for?

Answer 3

42 days

Question 4

What are the risks of transfusion?

4-ish

Answer 4

1. Transfusion-transmitted infection - viral, bacterial, parasitical or primal
2. Adverse effects of the leukocytes - immunomodulation, graft-versus-host disease, transfusion-related acute lung injury and alloimmunization
3. Acute volume or electrolyte disturbances
4. Blood group incompatibilities

Question 5

What is the combined risk of RBC contamination with viruses (Hepatitis A, B and C, HIV and Human T cell lymphotropic virus)

Answer 5

1 : 1.3 million

Question 6

What is the name of the process that reduces the risk of CMV?

Answer 6

leukoreduction

Question 7

What is the name of the process that reduces the adverse effects of the leukocytes?

Answer 7

gamma irritation - deactivates the lymphocytes

Question 8

What is the hematocrits of PRBC?

Answer 8

60%

Question 9

What type of blood is commonly issued to neonates?

Answer 9

If no time: rhesus -ve group O
If time: Rhesus matched group O

Alternatively, if it is not an emergency, you can do ABO grouping, Rh typing and screen for maternal antibodies

Question 10

When do you HAVE to give group specific blood

Answer 10

at four months.

they don’t tend to make their own antibodies until then

Question 11

When you receive PRBC for an infant, how long is that PRBC ok for.

Answer 11

4 hours

Question 12

What volume of blood do you transfuse and why?

Answer 12

10-20 ml/kg

higher volumes can increase RBC volume by 50% which can cause big fluctuations in Hb level and viscosity

Question 13

What is the rate of giving the PRBC?

Answer 13

non emergency: 5ml/kg/hr
semi emergency: 10ml/kg/hr
very emergency: 1 min push

Question 14

what are some of the risks of massive transfusion in emergency setting?

Answer 14

1. coagulopathy
2. hyperkalemia: the storage solution has potassium in it that increases with increasing storage days (day 1 = 1 mol/L, Day 20 = 20 mol/L, Day 52 = 52 mmol/L)

Question 15

Is there a transfusion threshold in Hemorrhagic shock?

Answer 15

No. You should go clinically, based on the history of delivery, and current clinical status. A threshold of 60g/L has been suggested, but not proven.

Question 16

What would you expect the mixed venous oxygen saturations to be of a healthy infant?

Answer 16

> 75%

indicates suficient reserve

Question 17

What is anaemia of prematurity

Answer 17

An exaggeration of physiological anaemia:

• poor response to EPO
• shorted RBC lifespan
• blood draw
• the rapid increase in blood volume with growth

Question 18

What are the threshold for transfusion as per PINT?

Answer 18

1st week:
- resp support: 115
- no resp support: 100
2nd week:
- resp support: 100
- no resp support: 85
3rd week:
- resp support: 85
- no resp support: 75

Question 19

Does using a restrictive transfusion threshold affect any outcomes?

Answer 19

No: they have lloyd at BPD, IVH, death, severe ROP, growth and disability.
Unclear the long term impact re subtle neurodevelopment outcome. Less severe definitions for disability favoured the higher transfusion threshold

Question 20

How do you make the decision to transfuse or not in a non-emergency situation?

Answer 20

Hb + hematocrits
Transfusion can decrease the HR and RR of neonates, so you can use these markers as indicators for transfusion in kids who would not support CVS stress

Question 21

Should we use EPO for treatment of anaemia?

Answer 21

No, it has an association with an increase in severe ROP so it is reserved for families who refuse transfusions (although some preparations have human albumin, so some parties may still decline)

Question 22

Should we use iron? and if yes, when?

Answer 22

Yes, Iron started at 4-6 weeks (the onset of reticulocytosis) have a higher Hb level and iron stores at 6 months
2 mg/kg