Red Cell Transfusion Practices in Neonatal Intensive Care Unit: An Experience from Tertiary Care Centre

Abstract

Red cells are the most often transfused blood components during the neonatal period. The aim of the present study was to obtain information regarding the relationship of red cell transfusion with clinical outcomes and to evaluate red cell transfusion practices in neonatal centre of a tertiary care centre. The clinical history, blood component details and laboratory parameters were evaluated with clinical outcomes. The neonates requiring transfusion of red cells were then followed up in the Blood bank for various laboratory parameters. Clinical parameters and clinical outcome were noted from case files. During the study period, 291 neonates were admitted in NICU. 2 neonates were excluded as they were congenitally malformed. Out of 289 admitted neonates, 61 neonates (21.1%) received blood and blood component transfusions. Out of 61 neonates, 20 received red cell transfusions. Mean donor exposure of red cells was 1.2. The mean volume of transfused red cell was 39.6 ml with mean age of red cells was 3.6 days. The mean pre-and post-transfusion Hct was 25.3 and 30.4%, respectively. The most common indication for red cell transfusion was low haemoglobin. There was a significant increase in lactate level and decrease in base excess in transfused neonates. However, no statistically significant correlations were found between transfusions and neonatal weight gain, apnoea, respiratory support and mortality. Transfusion of red cells has significant effect on laboratory parameters as compared to clinical parameters such as weight gain, episodes of apnoea and respiratory support.

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

“…As compared to normal birth weight neonates, extremely low birth weight neonates required more frequent platelet transfusions when they were diagnosed with thrombocytopenia [ 14 ]. One cannot extrapolate adult transfusion data to fill gaps in neonatal transfusion cutoff [ 3 ]. Hemoglobin level in neonates differs from adults because they are age-dependent.…”

“…The blood volume in a full-term newborn is approximately 85 ml/kg while that in a preterm newborn is about 100 ml/kg and that in an adult is about 70 ml/kg. The miniature blood volume and rookie organ systems in the neonate call for novel proposals in neonatal blood transfusion practice [ 3 ]. The physiological puerility of different organ systems can put at peril those very low birth weight babies (VLBW) to metabolic imbalance following transfusion and their additives, and infectious and immunological hazards such as graft-versus-host disease (GVHD) [ 4 ].…”

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.…”

Can Restrictive Approach in Neonatal Transfusion Justify the Clinical Outcome?

“…After evaluating, retrospectively, the transfusion practices in critically ill neonates over 19 mo, the incidence of transfusion was 58.4%, PRBC being the most frequently transfused blood component. Several studies have found that the incidence of neonatal transfusion ranges from 20 to 90% [1,2].…”