Blood Component Transfusion in Tertiary Care Neonatal Intensive Care Unit and Neonatal Intermediate Care Unit: An Audit

Abstract

Background Neonates admitted in a tertiary neonatal intensive care unit (NICU) require multiple blood transfusions because of extended NICU stay and repeated sampling. The rookie organ systems and miniature blood volumes in the neonate call for regular audits in neonatal blood transfusion practice. Sharing component usage data with the blood bank will prepare them to store components according to demand, thus limiting wastage of components as well as make banks ready to face a shortage in case of ramped up requirements. Objective Auditing neonatal blood transfusion indications and identifying the most commonly used component. Methodology This retrospective cohort study was conducted by the department of pediatrics over 22 months from February 20, 2017, to December 30, 2018. Any preterm and term neonates admitted to the NICU and Neonatal Intermediate Care Unit (NIMC) and receiving any transfusion, i.e., fresh frozen plasma (FFP), red cell concentrate (RCC), platelets, and exchange transfusion were included in our study. We collected data from the medical records of NICU and NIMC admitted patients receiving blood component transfusions from 2011 to 2016. Patients were categorized according to the classification of neonatal conditions by the International Classification of Diseases 11th Revision (ICD-11). There were no exclusion criteria. A descriptive statistical analysis was done, and a Chi-square test was applied. Results Out of 340 neonates, 249 (73.2%) were low birth weight, 139 (40.9%) were small for gestational age (SGA), and 277 (81.5%) neonates required transfusion during the first week of life. The majority of neonates require multiple transfusions. Fourteen(4.12%) neonates required up to 10 transfusions, two neonates required up to 22 transfusions, and 58 neonates required more than five blood transfusions. The majority required transfusion due to neonatal sepsis, Disseminated intravascular coagulopathy, low birth weight, respiratory distress syndrome, and unconjugated hyperbilirubinemia. Thirty-seven point eighty-two percent (37.82%) transfusions were fresh frozen plasma, 31.34% transfusions were red cell concentrate, 28.14% transfusions were platelet concentrate, and 2.70% were whole blood. Out of 340 neonates, 317 survived and were discharged. Conclusion The most commonly transfused component was fresh frozen plasma, the indication was neonatal sepsis, and the group was preterm. Whole blood is still being used and needs to be stopped.

Survey on Pattern and Determinants of Blood Transfusion in Benha Neonatal Intensive Unit

“…In the same way, Hameed et al (15) , reported that (62.9%) received packed red blood cells (PRBCs) followed by (18.6%) received exchange transfusion, (11.4%) received fresh frozen plasma and (7.1%) received platelets. In contrast to Amrutiya et al (16) , out of a total of 1002 transfusions, 37.82% consisted of fresh frozen plasma, 31.34 percent consisted of red cell concentrate, 28.14 percent consisted of platelet concentrate, and 2.70 percent consisted of whole blood.…”

Lead, Mercury, and Cadmium Concentrations in Blood Products Transfused to Neonates: Elimination Not Just Mitigation

“…The CSF is available only for Pb [ 35 , 43 ]. The maximum number of transfusions experienced in the neonatal period (first 28 days of life) was about 22 transfusions [ 44 ].…”

Neonatal and pediatric transfusion practices and policies in India: A survey‐based cross‐sectional assessment of blood centers

“…Greater than 80% of the participating blood centers in our study were part of a hospital/ hospital system. (Table 1) The data on transfusion practices in neonates and pediatrics is limited from India, as only a few academic care centers have published their experiences 4–7 . One of the reasons for such inappropriate data is due to highly variable transfusion practice both at the bedside (clinical use of blood) 8 as well as at the blood centers (blood banks) 9 .…”

“…(Table 1) The data on transfusion practices in neonates and pediatrics is limited from India, as only a few academic care centers have published their experiences. [4][5][6][7] One of the reasons for such inappropriate data is due to highly variable transfusion practice both at the bedside (clinical use of blood) 8 as well as at the blood centers (blood banks). 9 With recent advancements in transfusion medicine, aliquoting, component therapy, apheresis technology, and new available immune-hematological tests, the variation in blood center practices has widely increased.…”