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The Blood Transfusion Protocol. Latest
The Blood Transfusion Protocol. Latest
Neonates - Recent
Guidelines
Dr. Anand Bhattar
Learning Outcomes
• Specific pre-transfusion processing done
before transfusing blood products to
neonates ?
• It is essential that one considers the risk- benefit ratio and strive to develop
treatment strategies that will result in the best patient outcomes
Gamma irrardiation:
• It renders donor T lymphocytes ineffetive which is unable to mount a graft
versus host reaction in the immunologically incompetent neonate
Hematocrit:
• Should be 0.5 +/- 0.05
• A unit of blood with additional satellite packs should be ordered for each
infant & must be used up to its expiry date. This allows up to 8 transfusions
from a single donation
• The final product should be used within 24h of reconstitution & it has the same
characteristics as whole blood except for reduced platelets
Indications of whole blood:
o Exchange transfusion
o Cardiac surgery
◦ a. Rh incompatibility:
• If Blood arranged prior to birth: O negative cross matched against mother
• If Blood arranged after birth: Rh negative of baby’s ABO group is cross matched
against infant & mother
* Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, Peliowski A, Rios A, LaCorte M, Connelly R, Barrington K, Roberts RS. The
premature infants in need of transfusion (PINT) study: A randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low
birth weight infants. J Pediatr. 2006 Sep;149(3):301-7
Refer tables for selection of blood in new-born baby
up to the age of 4 months
Reason -
• <4 month rarely produce antibodies
(anti-A, anti-B) against blood group
antigen
Recommendations for plasma administration to neonates, based on scientific evidence and according to
the GRADE system
Recommended dose of FFP
• Assuming that FFP has an average clotting factor and inhibitor potency
of 1 IU/mL, dose of 10 mL/kg should increase clotting factors and
inhibitor levels by approximately 10 IU/dL (10%)
Hellstern P, Muntean W, Schramm W, et al. Practical guidelines for the clinical use of plasma. Thromb Res 2002;107(Suppl 1):S53–7
*Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the full-term infant. Blood 1987;70:165–72.
*Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the healthy premature infant. Blood 1988;72:1651–7.
*Christensen RD, Baer VL, Lambert DK, et al. Reference intervals for common coagulation tests of preterm infants (CME). Transfusion
2014;54:627–32.
• Most appropriate use of FFP should be the treatment of active bleeding in
neonates with laboratory confirmed coagulopathy
* Catford K, Muthukumar P, Reddy C, et al. Routine neonatal coagulation testing increases use of fresh-frozen plasma. Transfusion
2014;54:1444–5.
• Although there are no officially accepted guidelines, current evidence does
not support FFP administration to asphyxiated cooled neonates with
isolated abnormal clotting tests in the absence of bleeding
* Venkatesh V, Curley A, Khan R, et al. A novel approach to standardised recording of bleeding in a high risk neonatal population. Arch Dis Child Fetal
Neonatal Ed 2013;98:F260–3.
Platelet Transfusion
• Asymptomatic thrombocytopenia occurs in about 1% of term and
25% of preterm neonates
Garcia MG, Duenas E, Sola MC, et al. Epidemiologic and outcome studies of patients who received platelet transfusions in the neonatal intensive care unit. J
Perinatol 2001;21:415–20.
Del Vecchio A, Sola MC, Theriaque DW, et al. Platelet transfusions in the neonatal intensive care unit: factors predicting which patients will require multiple
transfusions. Transfusion 2001;41:803–8
• Repeated platelet transfusions were common with more than 50%
infants receiving more than one platelet transfusion during their
NICU stay
*Andrew M, Vegh P, Caco C, et al. Randomized controlled trial of platelet transfusions in thrombocytopenic premature infants. J Pediatr 1993; 123; 285-91
• The incidence of thrombocytopenia is inversely proportional to
the gestational age, and it represents a risk factor for poor
neonatal outcomes
• Etiology of Thrombocytopenia
• Early onset (<3 days of life) - Intrauterine growth restriction, pregnancy-
induced hypertension or diabetes, perinatal infection, and transplacental
passage of maternal allo- or autoantibodies
• This study showed that platelet counts at birth increased with advancing
gestational age
*Wiedmeier SE, Henry E, Sola-Visner MC, et al. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a
multihospital health-care system. J Perinatol 2009;29:130–6.
Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee
• Evidence indicates that, there is a poor correlation between
severity of thrombocytopenia and clinically significant bleeding
*Baer VL, Lambert DK, Henry E, et al. Severe thrombocytopenia in the NICU. Pediatrics 2009;124:e1095–100.
*Von Lindern JS, van den Bruele T, Lopriore E, et al. Thrombocytopenia in neonates and the risk of intraventricular hemorrhage: a retrospective cohort
study. BMC Pediatr 2011;11:16.
• Additional well designed randomized controlled trials are needed to
help identify safe and effective platelet transfusion thresholds for
neonates
FFP Must
Not required
Cryoprecipitate Preferred
Thank you…