Transfusion in Neonates (Eufrosina A. Melendres, MD)

Question 1

When transfusing in neonates, one should use what instead of a whole unit?

Answer 1

Aliquots

Question 2

Neonatal period

Answer 2

Birth up to four months

Question 3

Half-life of fetal red cells

Answer 3

45 - 70 days

Question 4

Composition of fetal red cells

Answer 4

53 - 95% Hb F

Question 5

Blood volume of newborns

Answer 5

Premature - ~100 mL/kg

Full-term - ~85 mL/kg

Question 6

Reason for larger blood volume in prematures compared to full-terms

Answer 6

Smaller body mass

Question 7

T/F: There is no difference in newborn and adult compensation for hypovolemia.

Answer 7

False

Newborn can’t compensate as well.

Question 8

Describe the infant’s bone marrow response

Answer 8

2 - 3 weeks to recover (compared to 4 - 6 in adults)

Question 9

Causes high metabolic rate, hypoglycemia, metabolic acidosis, apneic episodes leading to hypoxia, hypotension and cardiac arrest in newborns

Answer 9

Hypothermia

Question 10

Antibody present in the neonate

Answer 10

Maternal IgG

Question 11

Immature kidneys and livers in newborns can result in?

Answer 11

Acidosis
Hypocalcemia
Hyperkalemia

Question 12

T/F: Only symptomatic anemia is treated in neonates.

Answer 12

True

Question 13

T/F: Hematocrit alone is a precise and reliable indicator of anemia.

Answer 13

False

Question 14

Only indication for fresh whole blood (FWB) use in neonates

Answer 14

Exchange transfusion

Note: FWB has higher 2,3-DPG levels allowing faster release of O2.

Question 15

T/F: If the mother is iron deficient, the baby will be iron deficient.

Answer 15

True

Question 16

Also known as pure red cell aplasia wherein the bone marrow malfunctions and fails to make sufficient RBCs

Answer 16

Diamond Blackfan Anemia

Question 17

Salient features of pathologic anemia in the newborn

Answer 17

Tiring at feeding
Cardiomegaly on X-ray w/ tachycardia or tachypnea
Hypoxemia (warrants RBC transfusion)

Question 18

Laboratory evidence for pathologic anemia in the newborn

Answer 18

Hb - below 100 g/L (term) or 120 g/L (small preterm)
Hct - below 30% (term) or 40% (sick preterm)

Note: Hct may be unreliable. Correlate with other labs.

Question 19

Main oxygen transport protein in fetus for last seven months of development in utero

Answer 19

Fetal hemoglobin (Hb F)

Question 20

Why does fetal hemoglobin have a greater affinity for oxygen?

Answer 20

Lack of interaction with 2,3-biphosphoglycerate

Question 21

Storage duration of platelets and packed RBCs

Answer 21

Platelets - 5 days

PRBCs - 5 weeks

Question 22

Describe: Quadruple pack

Answer 22

Provides 1 unit plasma & 3 80 mL or 6 40 mL aliquots of RBCs

Question 23

Describe: Half unit donation

Answer 23

2 60 mL aliquots of RBCs

Question 24

There is risk of this in infants who receive transfusions in a high-oxygen environment.

Answer 24

Retrolental fibroplasias

Question 25

Characteristics of infants predisposed to retrolental fibroplasias

Answer 25

Premature
Birth weight < 1,500 g
Placed in high-oxygen environment

Question 26

T/F: There is risk of CMV infection during transfusion in newborns.

Answer 26

True

Question 27

Before transfusion, blood should ideally undergo this procedure.

Answer 27

Gamma-irradiation

Question 28

Direct transfusion donations from first-degree relatives cause this disease

Answer 28

Graft-versus-host disease (GVHD)

Question 29

Choice of blood for ABO incompatibility

Answer 29

Type O, Rh+ FWB

Question 30

Choice of blood for Rh incompatibility

Answer 30

ABO-specific, Rh- FWB

Question 31

Golden period for returning unused blood to the blood bank

Answer 31

30 minutes

Question 32

Type of solution that should be run with PRBC and WB

Answer 32

Normal saline solution (NSS)

Question 33

Maximum infusion time

Answer 33

4 hours per unit

Question 34

Given instead if fresh whole blood is unavailable

Answer 34

Packed RBCs + Fresh Frozen Plasma (FFP)

Question 35

When is whole blood considered fresh?

Answer 35

< 5 days old

Question 36

How long is the rest period post transfusion?

Answer 36

8 - 10 hours

Question 37

Guidelines for use of fresh frozen plasma (FFP)

Answer 37

Transfuse within 24 hours after thawing and within 6 hours to avail of labile factors

Question 38

Components of the cryoprecipitate

Answer 38

I, V, VIII, XIII and Von Willebrand Factor

Question 39

Components of the cryosupernate

Answer 39

II, VII, IX, and X (Vit. K dependent factors)