Variations in Transfusion Practice in Neonatal Intensive Care

Ringer, Steven A.; Richardson, D K; Sacher, Ronald A.; Keszler, Martin; Churchill, W. Hallowell

doi:10.1542/peds.101.2.194

Cited by 141 publications

(79 citation statements)

References 33 publications

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“…While transfusions in the NICU are relatively common, evidence-based criteria for when to administer them are lacking. 16 Consequently, in many NICUs, transfusions are ordered at the discretion of each individual practitioner, and much variation is observed. Many recent studies have reported benefits of instituting written transfusion guidelines for NICU patients.…”

Section: Discussionmentioning

confidence: 99%

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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Objective: We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of noncompliance that could be addressed by quality improvement measures. Result: During 2006 the three NICUs cared for 1759 neonates. Seventeen percent of these received one or more (median 3) erythrocyte transfusions, 4% received one or more (median 3) platelet transfusions, 6% received one or more (median 1) FP infusions and 2% received cryoprecipitate (median 1 dose). Seventy percent of the erythrocyte transfusions were given in compliance with the guidelines, as were 69% of the platelet transfusions, 65% of the FP transfusions and 94% of the cryoprecipitate administrations. Patients who received large numbers of transfusions were more likely to receive transfusion that violated the guidelines. Forty-five percent of patients who received 1 to 3 transfusions received all transfusions within guidelines. However, only 18% of patients who received 4 to 10 transfusions received all within guidelines. No patient who received >10 transfusions received all within the guidelines. Erythrocyte transfusions given early in the hospital course were likely to be within guidelines; 72% (588/818) in the first 29 days were compliant with guidelines, but compliance fell to 61% (144/237) for transfusions administered after 29 days (P ¼ 0.002). About half of the platelet transfusions given early in the hospital course were in violation of guidelines, but after day 9, 83% of platelet transfusions were compliant with guidelines (P ¼ 0.000). Conclusion:Opportunities exist in our healthcare system to improve compliance with our transfusion guidelines. Such opportunities are greatest among neonates receiving multiple transfusions, among those receiving erythrocyte transfusions late in their NICU course and among those receiving platelet transfusions early in their NICU course.

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Section: Discussionmentioning

confidence: 99%

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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“…4 Patients with NEC or sepsis commonly receive erythrocyte transfusions. 55,56 Hemolytic anemia is common with NEC. Red blood cell morphology is consistent with thrombotic microangiopathy and includes teardrops, schistocytes, spherocytes, and acanthocytes.…”

Section: Anemia Pathophysiology Of Anemiamentioning

confidence: 99%

“…55,56 With the dramatic decrease in the number of transfusions administered to premature infants in the last 10 years, 63 a study that addresses the number and outcome of transfusions given to patients diagnosed with NEC would be informative. A potentially lethal complication of erythrocyte transfusion may occur in infants with T cryptantigen exposed on the surface of endogenous erythrocytes if antibodies to T cryptantigen are present in transfused whole blood, platelets, or fresh frozen plasma.…”

Section: Treatment Of Anemiamentioning

confidence: 99%

Hematologic Abnormalities in Severe Neonatal Necrotizing Enterocolitis: 25 Years Later

Kling

Hutter

2003

J Perinatol

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Necrotizing enterocolitis (NEC), the most common surgical emergency in newborns, remains a therapeutic challenge for clinicians. The hematological manifestations associated with NEC were first described 25 years ago. This review discusses current knowledge of the pathophysiology involved in disturbances in megakaryocytopoiesis, coagulation, leukopoiesis, and erythropoiesis that accompany the clinical entity NEC. The discussion includes current understanding of and potential strategies for treating the hematopoietic disturbances that occur secondary to NEC.

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“…2 Many of these are newborns with congenital anomalies and/or dysmorphic features. Sometimes the need for chromosome testing does not become apparent until after the neonate has had one or more transfusions, creating a dilemma.…”

Section: Discussionmentioning

confidence: 99%

Packed red cell transfusion does not compromise chromosome analysis in newborns

Kulharya

Salbert

Norris

et al. 2001

Genetics in Medicine

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Purpose: Critically ill neonates are frequently transfused with packed red cells. Some of these transfused neonates also need chromosome analysis. There is a long-standing tradition in pediatrics of not performing chromosome analysis after transfusion. We wished to determine whether transfusion with packed red cells affect the cytogenetic results in neonates. Method: The medical records of all neonates at the Medical College of Georgia who had had chromosome analysis between June 1995 and June 1998 were reviewed. Ten neonates had received transfusion prior to cytogenetic testing. Of these 10 infants, two had been transfused two or more times. Routine cytogenetic analysis of 20 metaphases at 550-band level had been performed on all 10 patients. Heteromorphic markers were compared in 10 randomly selected metaphases for any discrepancy. To determine whether there were theoretical reasons to delay chromosome analysis in transfused neonates, samples of irradiated, and/or filtered, and nonfiltered blood were obtained from the blood bank and analyzed for the presence of lymphocytes. Results: Prior transfusion did not affect karyotype results. A nonmosaic abnormal karyotype was found in 3 of the 10 patients.A fourth patient's karyotype was 45,X/47,XXX. This mosaicism was constitutive and consistent as demonstrated by a follow-up chromosome analysis. All other abnormal karyotypes were consistent with the dysmorphic phenotype. Randomly selected metaphases did not show any differences in the identifiable heteromorphic markers in all 10 patients. Although there was a 50% chance of patients receiving blood from a donor of opposite sex, there were no instances in which cells with a karyotype of the opposite sex were found in the patients' blood. The irradiated and filtered cultured donor blood samples did not show any metaphases. However, metaphases were seen in the cultures from nonfiltered and nonirradiated donor blood. Conclusions: Based on these results one does not need to delay karyotyping babies who have had blood transfusions. Packed red cell transfusion in newborns does not compromise the accuracy of chromosome analysis in our study even with multiple transfusions. Genetics in Medicine, 2001:3(4):314 -317.

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Variations in Transfusion Practice in Neonatal Intensive Care

Cited by 141 publications

References 33 publications

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Hematologic Abnormalities in Severe Neonatal Necrotizing Enterocolitis: 25 Years Later

Packed red cell transfusion does not compromise chromosome analysis in newborns

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