Guidelines for administration of blood products: transfusion of infants and neonates

Voak, D.; Cann, R. J.; Finney, R.; Fraser, I.D.; Mitchell, R.; Murphy, Mike; Phillips, Peter; Rejman, A.; Waters, A. H.; Wood, J. K.; Gibson, Brenda; Hann, IM; Holland, B M; Letsky, Elizabeth A.; Napier, J. A. F.; Silva, M.; Wardrop, C. A. J.; Webb, Michelle

doi:10.1111/j.1365-3148.1994.tb00245.x

Cited by 67 publications

(14 citation statements)

References 6 publications

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“…In line with our survey, recommendations changed and directed blood donations disappear, since they are not safer than volunteer donations [21] and the risk of alloimmunization is higher.…”

Section: Discussionsupporting

confidence: 61%

Low degree of regionalization and high transfusion rates in very low birthweight infants: A survey in Germany

Maier¹,

Metze²,

Obladen³

1998

Jpme

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Although anemia is common in very low birthweight (VLBW) infants, widely accepted guidelines for red blood cell transfusions are lacking. Questionnaires regarding transfusion policy in VLBW infants in 1994 were sent to 391 German pediatric departments. 208 questionnaires were returned. 51 departments reported not to admit VLBW infants. Thus, results are based on 157 completed questionnaires. 54% of the respondents admitted less than 30 VLBW infants per year and 52% of the VLBW infants were admitted to departments with less than 50 VLBW infants per year. Overall transfusion rate ranged from 0 to 100% (median 65%). This range narrowed with the departments' size indicating stricter guidelines with less variation. Indication for transfusion varied considerably depending on the infants' postnatal age and need for ventilatory support. 34% of the respondents applied directed transfusions, most frequently from the infant's father. 70% used satellite packs. 51% stored the packs up to 7 days, 10% longer than 14 days. Red cells were irradiated in 35%, and washed in 23% of the departments. Median single transfusion volume was 12 ml/kg. We conclude that regionalization of VLBW infants in Germany is far from completeness and that hospital policies for transfusion show large variety especially in small departments.

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“…In line with our survey, recommendations changed and directed blood donations disappear, since they are not safer than volunteer donations [21] and the risk of alloimmunization is higher.…”

Section: Discussionsupporting

confidence: 61%

Low degree of regionalization and high transfusion rates in very low birthweight infants: A survey in Germany

Maier¹,

Metze²,

Obladen³

1998

Jpme

View full text Add to dashboard Cite

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“…In fact, our new thresholds for anemia were comparable to those used to investigate the effects of a restrictive transfusion policy [17] and were more restrictive than those suggested in recent British guidelines [18]. Whichever hemoglobin level is used to define anemia, it is common clinical practice also to require clinical signs for anemia before giving a blood transfusion (at least as long as the hematocrit value remains above approximately 20%) [17,18]. These clinical signs include tachycardia, tachypnea, poor feeding, and recurrent apnea.…”

Section: Discussionmentioning

confidence: 69%

“…While the clinical relevance of our negative answer to this question in a previous study [10] could be challenged due to the comparatively high hemoglobin levels used to define anemia -which had been based on studies investigating the effect of erythropoietin [15,16] -, this potential caveat does not apply to the present study. In fact, our new thresholds for anemia were comparable to those used to investigate the effects of a restrictive transfusion policy [17] and were more restrictive than those suggested in recent British guidelines [18]. Whichever hemoglobin level is used to define anemia, it is common clinical practice also to require clinical signs for anemia before giving a blood transfusion (at least as long as the hematocrit value remains above approximately 20%) [17,18].…”

Section: Discussionmentioning

confidence: 74%

Blood Transfusion in Anemic Infants with Apnea of Prematurity

Westkamp

Soditt²,

Adrian³

et al. 2002

Neonatology

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We found recently that blood transfusions had no effect on bradycardia and hypoxemia, the clinically important components of apnea of prematurity, in mildly anemic infants. Here, we wanted to know whether this also holds true for more severely anemic patients. Nineteen preterm infants, median gestational age at birth 25 (range 22–30) weeks, age at the time of study 5.5 (range 1–13) weeks, for whom a blood transfusion was ordered because of recurrent episodes of bradycardia and/or hypoxemia in conjunction with anemia (median hemoglobin level 78 g/l, range 63–98 g/l) were investigated. One infant received two transfusions and was thus studied twice. 4-hour recordings of pulse oximeter saturation (SpO₂), pulse waveforms, electrocardiogram, breathing movements, and nasal airflow were performed immediately before transfusion of 20 ml/kg packed red blood cells and again 24 h later. The recordings were analyzed for baseline heart and respiratory rates and SpO₂, all measured during regular breathing, as well as for apnea (≧20 s), bradycardia (heart rate <2/3 of baseline for ≧4 s), and episodic desaturation (SpO₂ ≤80% for ≧4 s). There was no significant change in the combined frequency of bradycardia and desaturation, the primary study end point – median 6.4/h (range 3.0–13.5/h) before versus 4.6/h (range 0.6–15.7/h) after transfusion –, although there was slightly less bradycardia – 0.8/h (range 0.0–8.8/h) versus 0.7/h (range 0.0–5.1/h; p < 0.05). Baseline heart and respiratory rates decreased, respectively, from 163/min (range 140–182/min) and 58/min (range 34–98/min) to 152/min (range 134–172/min) and 55/min (range 36–82/min; p < 0.01). We conclude that blood transfusions significantly reduced heart and respiratory rates in these anemic infants, but had little effect on apnea of prematurity.

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“…There have been British efforts at formulating national guidelines. The British Committee for Standards in Haematology looked specifically at transfusion schedules for infants and neonates 32 . The Royal College of Physicians of Edinburgh held a consensus conference addressing the variations in transfusion practice, the need for clinical guidelines, the need to inform and to be informed of the hazards and benefits and the methods to translate these into a change in transfusion practice 33 .…”

Section: Indications For Red Cell Transfusionmentioning

confidence: 99%