RBC Transfusions in Newborns Flashcards
Define physiological anemia
- Seen in term babies, hemoglobin concentration declines between 8-12 weeks of life, remains stable for several weeks and increases progressively
- Asymptomatic
Define non physiologic anemia
- Develops earlier than physiologic (4-12 weeks)
- Symptomatic (tachycardia)
What is the most common cause of non physiologic anemia?
Iatrogenic (phlebotomy)
List strategies to prevent and reduce severity of anemia
- Delayed umbilical cord clamping
- Restricted blood sampling
- Using recombinant human EPO to stimulate erythropoeisis
- Iron supplementation or vitamins to minimize severity of anemia
- Appropriately collected + stored multipack RBC units
- Appropriately screnned + handled RBCs from designated donors
- Collecting and transfusing umbilical cord blood
What is the evidence for delayed cord clamping?
Several RCTs showed delayed cord clamping compared with early cord clamping reduced the need for transfusion without increasing adverse outcomes
How can we restrict blood loss?
- Decreasing uneccessary blood work
- Returning dead space volume after art line sampling
- Microtechnique lab procedures
- Noninvasive monitoring methods
Where is fetal and neonatal EPO produced?
Fetus: liver
Neonate: kidney
Why is the infant response to hypoxia reduced?
- Poor sensitivity of liver oxygen sensors
- Immature renal oxygen sensors
What is a major cause of anemia of prematurity?
EPO deficiency
How effective is EPO administration?
Same effect as restrictive guidelines for RBC transfusion
What is the evidence for EPO?
- Several studies have shown beneficial effects but in association with conservative transfusion criteria, minimizing phlebotomy and early Fe supplementation
- Meta-analysis of RCTs studying efficacy of EPO in preventing RBC transfusions showed benefits when combined with conservative RBC transfusion criteria
- Authors concluded EPO should not be a standard tx for anemia of prematurity
Does EPO change the need for transfusions in the first two weeks of life?
NO!
What dose of supplemental iron is required by prems to prevent late anemia?
4-4.5mg/kg
What dose of vitamin E is required to prevent hemolytic anemia?
25IU
What type of preservative is used for the preservation of RBCs since 1993?
- Adenine-saline anticoagulant (AS3)
- RBCs can be stored for at least 4 weeks
What age of blood can be used for rapid and large volume tranfusions?
< 5 days old
What is the advantage of having a long storage period for blood products?
- Increased availability of blood
- Limits donor exposure
Why do we not use blood older than 5 days for rapid and large volume blood transfusions?
- Serum potassium substantially elevated
- Blood older than 5 days can still be used for slow, small volume top up transfusions
When should babies get irradiated blood?
- If donated blood is obtained from first or second degree relatives
- Fetuses getting intrauterine transfusions
- Immunocompromised infants
- Infants who previously received an in utero transfusion
When should babies get blood irradiated < 24 hours ago?
When clinical risk of hyperkalemia is significant
What infectious things are blood products screened for?
- HIV1, HIV2
- HTLV1, HTLV2
- Hepatitis B surface antigen
- Syphilis
- CMV
Can low birthweight infants receive CMV positive blood?
Uncertain whether leukodepletion is adequate for prevention of CMV, most guidelines recommend CMV negative blood
What is the benefit of leukodepletion for newborn infants?
No proven benefits but probably no disadvantages
What is the most important approach to reducing donor eposure?
Use of multipack collection systems
