2. Blood Transfusion in The Neonate Dr.Boskabadi Neonatologist

3. Pathophysiology of Neonatal Anemia (I) Physiologic factor Healthy term infants: 9g/dL Infants weighing 1.0-1.5kg: 8g/dL Infants weighing < 1.0kg: 7g/dL Red blood cell (RBC) transfusion provides an immediate increase in oxygen delivery to tissues and is an effective and rapid intervention to treat anemia.

4. Pathophysiology of physiologic Neonatal Anemia (II) Diminished EPO output in response to anemia Inadequate production of EPO Location production EPO HB F Change Blood Volume

5. Pathophysiology of Neonatal Anemia (III) Phlebotomy blood losses 1.Sampling has range from 0.8-3.1 ml/kg/d 2.Total RBCs lost during hospitalization 30%-300% of the total circulating RBC volume

6. RBC Transfusions to Treat Neonatal Anemia (I) Maintain Hct > 40% for severe cardiopulmonary disease Maintain Hct > 30% for moderate cardiopulmonary Surgery Hct < 30% Blood loss>25%

7. RBC Transfusions to Treat Neonatal Anemia (II) Maintain Hct > 25% for symptomatic anemia –Unexplained breathing disorder –Unexplained abnormal vital sign –Unexplained poor growth –Unexplained diminished activity

8. For infants requiring moderate or significant mechanical ventilation, defined as fraction of inspired oxygen (FiO2) >0.4, and mean airway pressure (MAP) >8 cm H2O on a conventional ventilator or MAP >14 on a high frequency ventilator, the hematocrit trigger is <30 percent (hemoglobin ≤10 g/dL).

9. In asymptomatic infants, the hematocrit trigger is less than 18 percent (hemoglobin ≤6 g/dL) with an absolute reticulocyte <100,000/microL (<2 percent). symptomatic infant with a "hemoglobin falling below 6 gm/dL with an absolute reticulocyte count less than 100,000 to 150,000/microL, which suggests low plasma concentration of erythropoietin

10. Criteria for ABO and Rh Compatibility of Blood Components ABO Group (Infant)ABO Group (RBCs and Granulocytes) ABO Group (FFP or Platelets) OOO, A, B, or AB AA or OA or AB BB or OB or AB ABAB, A, B or OAB

11. Guidelines for Rh-Compatible Blood Components Rh Type (Infant) Rh Type (RBCs and Granulocytes) Rh Type (FFP) PositivePositive or negative Negative Positive or negative

12. Indications for Administering Irradiated Blood Components to Neonates Congenital or acquired cellular immunodeficiency Intrauterine transfusion transfusion <1500 g Chemotherapy or radiation treatment Bone marrow or peripheral blood stem cell transplant Transfusion of a cellular blood component obtained from a blood relative

13. Red Blood Cell Product for Transfusion (I) Fresh RBCs v.s Stored RBCs (i) –The rise in plasma K+ levels After 42 days storage, plasma K+: 0.05meq/ml Given a 15ml/kg transfusion of pRBCs will received 3ml extracellular fluid, or 0.15 meq K+ Not apply to large-volume transfusion or infused rapidly

14. Recombinant EPO to Treat Neonatal Anemia The role of EPO therapy to treat this condition is undefined It seems reasonable to treat stable infants weighing 0.8-1.3kg with EPO

15. Complication inhibiting erythropoiesis infection, graft-versus-host disease, transfusion related acute lung injury (TRALI), transfusion associated circulatory overload (TACO),

16. Infection Bacterial Brucellosis Escherichia coli Yersinia enterocolitica Syphilis Parasitic/Protozoan Babesiosis Chagas disease Filariasis Malaria Toxoplasmosis Trypanosomiasis Viral Cytomegalovirus Epstein-Barr virus Hepatitis A Hepatitis B Hepatitis C Hepatitis G Human immunodeficiency virus (HIV) Human parvovirus Human T-cell leukemia virus I/II