Blood Transfusion In Neonates
Management guidelines for students, interns and registrars on a variety of routine and emergency situations in our neonatal service at Tygerberg Children’s Hospital. Published in 2014.
Indications for consideration of blood transfusions
Indications for consideration of blood transfusions
- HCT ≤ 35% or Hb ≤ 12 g/dl and any of:
- Hypovolaemia/shock. Correct haematocrit (HCT) to 40%
- Severe respiratory distress and mechanical ventilation with FiO2 > 50%
- Severe congenital heart condition with cyanosis or heart failure
- HCT ≤ 30% or Hb ≤ 10g/dl and any of:
- Moderate respiratory distress with FiO2 > 35% on either nasal cannulae
or IMV with PAW 6 – 8 cm H2O
- Moderate respiratory distress with FiO2 > 35% on either nasal cannulae
- HCT ≤ 25% or Hb ≤ 8g/dl and any of:
- Mild respiratory distress with FiO2 25 – 35% on nCPAP or IMV or nasal cannulae
- Repeated apnoea attacks/bradycardia of ≥ 10 episodes/24 hours or ≥ 2 episodes requiring bag ventilation
- Sustained tachycardia (> 180/min) or sustained tachypnoea (>80/min)
- Reduced weight gain for 4 days (≤ 10g/day despite ≥ 420 kJ/kg/day)
- HCT ≤ 20% or Hb ≤ 7g/dl and reticulocytes <4% (or absolute count < 100 000/ml)
Type and volume
Usually packed red cells 15 - 20 ml/kg.
Whole blood if shocked and anaemic, give whole blood 25 ml/kg.
Do not correct haematocrit > 45%.
If a preterm baby < 1500g requires a blood transfusion (or if a baby will require several blood transfusions), request blood bank to issue "Limited Donor Exposure Program" (LDEP)-BLOOD. In this case 150 ml bags of donor blood are divided into 3 bags of 50 ml each; these are available for 42 days for that baby. Repeated cross matches not required.
Blood at TCH administered to babies less than 1 year of age has already been filtered for CMV and is leucocyte free. Administration filter not required.
Consent
Doctor must obtain written informed consent from the parents for blood transfusion prior to administration. Use consent form.
Indication for transfusion as well as possible risks (e.g. HIV transmission) must be discussed with parents.
Document that consent obtained and risks discussed in the baby’s folder.
In case of an emergency situation and parents not available for consent, obtain consent from medical superintendent (and later from parents when they are contactable).
Administration
Consult with your consultant if blood transfusion is considered.
Except in emergency, consider transfusing within normal working hours. Extra costs after-hours.
Administer with volumetric infusion pump over 2 - 4 hours.
Use blood filter if blood is not filtered through PAL filter.
In babies with severe respiratory distress, PDA, BPD, cardiac failure, etc, be extremely careful with blood (packed red cells) administration and consider administration of 1mg/kg IV Furosemide (Lasix®) halfway through transfusion.