Red blood cell transfusion in newborn infants

Question 1

What are the risks of transfusion?

Answer 1

1. Transfusion-transmitted infections (viral, bacterial, parasitical or prional),
2. The adverse effects of leukocytes (including immunomodulation, graft-versus-host disease; transfusion-related acute lung injury and alloimmunization),
3. Acute volume or electrolyte disturbances, and
4. Blood group incompatibilities (often mistransfusion errors).

Question 2

What is the recommended transfusion for neonates?

Answer 2

pRBC type O with compatible Rh type, CMV negative, irradiated

Can use non-group O RBCs is passive maternal anti-A or anti-B is not detected in serum or plasma

Question 3

What is the recommended dose for pRBC?

Answer 3

5-20mL/kg/dose over 4h on pump

Consider utilizing target of 150g/L in early period then 130g/L and calculating volume needed

Question 4

What are indications for RBC transfusion in newborns?

Answer 4

1. Hemorrhagic shock
2. Anemia
3. Anemia of prematurity

Question 5

What are the hemoglobin threshold for transfusion in the newborn?

Answer 5

Week 1: respiratory support 115 No respiratory support 100

Week 2: resp support 100, no resp support 85

> Week 3: resp support 85
no resp support 75

Question 6

What is the recommendations re: ertyhropoeitin?

Answer 6

Little support for use of EPO except in families who withold consent trasfusion

Question 7

What is the role of hematinic support?

Answer 7

Start supplementation of elemental iron 2mgkg/day at 4-6 wks old

Question 8

What are the CPS recommendations for clinicians?

Answer 8

1. Group O Rh-negative blood may be used in the emergency transfusion of newborns. Otherwise, either group O Rh-compatible or group-specific Rh-compatible blood must be used. Starting at four months postnatal age, cross-matching of donor blood is required.
2. In cases of massive hemorrhage, for which a large volume of blood may be required, care should be taken to avoid hyperkalemia and dilution of coagulation factors, using combined replacement with fresh frozen or frozen plasma, as necessary.
3. ‘Top-up’ transfusions should be used to maintain hemoglobin levels >75 g/L in convalescent preterm infants.
4. For infants in the first and second week of life, minimum hemoglobin levels of 100 g/L and 85 g/L, respectively, are recommended.
5. Infants needing respiratory support may require transfusion at higher hemoglobin thresholds (see Table 1).
6. Infants with cyanotic heart disease or similar hemodynamic disorders may require transfusion at higher hemoglobin thresholds.
7. Transfusions should not be used to improve weight gain or to address apnea of prematurity when hemoglobin levels are already in excess of recommended levels for maintenance.

Question 9

What are the CPS recommendations for policy makers?

Answer 9

Blood products for transfusion of the newborn must be provided by an agency regulated by Canadian public health authorities.

Question 10

What is the guidelines re: consent?

Answer 10

Requires consent of a child’s parent or guardian unless emergency

If conflict in decision makers and the health care team see previous CPS statements for guidance (Jehovah’s Witness)