BLOOD COMPONENT THERAPY in the Newborn Amit Ray Kolkata

Of all patient groups preterm infants are one of the most frequently transfused Unique features of neonates: immature immune system, difficult to cope with metabolic load, presence of mat Abs

Current trends More aware of risks of Tx: AIDS epidemic; other infections e.g. CMV, HBV, HCV, Parvo, malaria; ROP; TAGVHD Window period: HBsAg 59 days Scarce commodity Hence RESTRICT no of transfusions, avoid unnecessary sampling, Micro-techniques, noninvasive monitoring, rhEPO

RBC Tx in newborn- Guidelines 1 PCV < 20, low Retics, symptoms 2 PCV < 30, with 6 apnea/brady in12h req bagging, HR >180 x 24h, RR >80 x 24h 3 PCV 35% O2 by Hbox or CPAP/IMV (map 6-8) 4 PCV <45 with cong cyan ht ds

RBC Tx Small vol Tx with Packed RBC concentrate (PCV 70-90) Preservative CPD, AS-3 Infuse over 2-4 h, Dose 15 ml/kg 2,3 DPG >70% in 1 st 5 days

TAGVHD Immune response mounted by donor T- cells against host tissues fatal syndromewasting, dermatitis, hepatitis, GIT sympt., marrow suppression, high fever by 4 days of tx Fresh blood < 96 h old a risk factor Irradiation of blood from immediate relatives– imp for large vol Tx only

FFP Used to replace coagulation factors ml/kg may repeat 12-24hrly NOT indicated for vol expansion

Indications for FFP HDN with sign. Haemorrhage Isolated factor deficiency Replacement in AT III, prot C or S def. DIC Bleeding following massive transfusion Therapeutic plasma xchange in TTP

Platelet concentrate From centrifugation of whole blood Final conc 85% (50-70 lakh/cu.mm) Some white cells inevitably present 1 unit of random donor raises plt count to >1lakh/cu.mm, by infusing 5-10 ml/kg of std platelet conc. Plt shd be Rh & ABO specific

Guidelines for Plt Tx < 30k in term NB with failure of production < 50k in stable prem with active bleed or invasive procedure in DIC pt <1 lakh in sick prem with active bleed or invasive procedure in DIC pt Active bleed in pt of Plt Quality defect Unexplained xcessive bleed in cardio-pulm bypass ECMO with plt < 1lakh or with bleeding

Granulocyte Tx Possible role in sepsis in conjunction with antibiotics Optimal use yet to be established Only useful if obtained by leukopheresis Must be irradiated

Whole blood Rarely required Ind.– blood loss, cardiac surgery, exchange Tx

Conclusions RBC Tx remains an essential part of mge of hi risk prems Focus on prev of anaemia, donor restriction and restriction of no of TX Be aware of the potential for harm esp infections. Avoid unnecessary Tx.