Transfusion in Neonates (Eufrosina A. Melendres, MD) Flashcards
When transfusing in neonates, one should use what instead of a whole unit?
Aliquots
Neonatal period
Birth up to four months
Half-life of fetal red cells
45 - 70 days
Composition of fetal red cells
53 - 95% Hb F
Blood volume of newborns
Premature - ~100 mL/kg
Full-term - ~85 mL/kg
Reason for larger blood volume in prematures compared to full-terms
Smaller body mass
T/F: There is no difference in newborn and adult compensation for hypovolemia.
False
Newborn can’t compensate as well.
Describe the infant’s bone marrow response
2 - 3 weeks to recover (compared to 4 - 6 in adults)
Causes high metabolic rate, hypoglycemia, metabolic acidosis, apneic episodes leading to hypoxia, hypotension and cardiac arrest in newborns
Hypothermia
Antibody present in the neonate
Maternal IgG
Immature kidneys and livers in newborns can result in?
Acidosis
Hypocalcemia
Hyperkalemia
T/F: Only symptomatic anemia is treated in neonates.
True
T/F: Hematocrit alone is a precise and reliable indicator of anemia.
False
Only indication for fresh whole blood (FWB) use in neonates
Exchange transfusion
Note: FWB has higher 2,3-DPG levels allowing faster release of O2.
T/F: If the mother is iron deficient, the baby will be iron deficient.
True
Also known as pure red cell aplasia wherein the bone marrow malfunctions and fails to make sufficient RBCs
Diamond Blackfan Anemia
Salient features of pathologic anemia in the newborn
Tiring at feeding
Cardiomegaly on X-ray w/ tachycardia or tachypnea
Hypoxemia (warrants RBC transfusion)
Laboratory evidence for pathologic anemia in the newborn
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.
Main oxygen transport protein in fetus for last seven months of development in utero
Fetal hemoglobin (Hb F)
Why does fetal hemoglobin have a greater affinity for oxygen?
Lack of interaction with 2,3-biphosphoglycerate
Storage duration of platelets and packed RBCs
Platelets - 5 days
PRBCs - 5 weeks
Describe: Quadruple pack
Provides 1 unit plasma & 3 80 mL or 6 40 mL aliquots of RBCs
Describe: Half unit donation
2 60 mL aliquots of RBCs
There is risk of this in infants who receive transfusions in a high-oxygen environment.
Retrolental fibroplasias
Characteristics of infants predisposed to retrolental fibroplasias
Premature
Birth weight < 1,500 g
Placed in high-oxygen environment
T/F: There is risk of CMV infection during transfusion in newborns.
True
Before transfusion, blood should ideally undergo this procedure.
Gamma-irradiation
Direct transfusion donations from first-degree relatives cause this disease
Graft-versus-host disease (GVHD)
Choice of blood for ABO incompatibility
Type O, Rh+ FWB
Choice of blood for Rh incompatibility
ABO-specific, Rh- FWB
Golden period for returning unused blood to the blood bank
30 minutes
Type of solution that should be run with PRBC and WB
Normal saline solution (NSS)
Maximum infusion time
4 hours per unit
Given instead if fresh whole blood is unavailable
Packed RBCs + Fresh Frozen Plasma (FFP)
When is whole blood considered fresh?
< 5 days old
How long is the rest period post transfusion?
8 - 10 hours
Guidelines for use of fresh frozen plasma (FFP)
Transfuse within 24 hours after thawing and within 6 hours to avail of labile factors
Components of the cryoprecipitate
I, V, VIII, XIII and Von Willebrand Factor
Components of the cryosupernate
II, VII, IX, and X (Vit. K dependent factors)
