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BLOOD COMPONENT THERAPY FOR THE NEONATE

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Presentation on theme: "BLOOD COMPONENT THERAPY FOR THE NEONATE"— Presentation transcript:

1 BLOOD COMPONENT THERAPY FOR THE NEONATE
Dehdashtian M. Neonatologist, Associated professor of pediatrics Ahvaz Jundi Shapur University of Medical Science

2 BLOOD COMPONENT THERAPY FOR THE NEONATE
RBC transfusion Platelet transfusion FFP transfusion Cryoprecipitate transfusion IVIG Granulocyte transfusion

3 Red Blood Cell Transfusion
Anemia in newborn is indicated by: Central venous hemoglobin<13gr/dl or capillary hemoglobin<14.5gr/dl Anemia occurs when the red blood cell mass does not adequately meet the oxygen demands of the tissue

4 Risk of Transfusion Therapy
Metabolic Complications Immunologic Complications Transfusion-Related Necrotizing Enterocolitis Transfusion-Related Intraventricular Hemorrhage Infectious Complications

5 Metabolic Complications
Hypoglycemia Hyperkalemia Hypocalcemia

6 Immunologic Complication
Hemolytic Transfusion Reactions Febrile Nonhemolytic Transfusion Reactions Allergic Transfusion Reactions Transfusion Associated Graft Versus Host Disease Transfusion Related Acute Lung Injury T-Antigen Activation

7 Transfusion-Related Necrotizing Enterocolitis
A temporal association may be exist between RBC transfusion and NEC The risk of transfusion associated NEC increases with decreasing gestational age of the infant

8 Transfusion-Related Intraventricular Hemorrhage
Early RBC Transfusion may be play a role in IVH development or extension

9 Infectious Complications
CMV Infection Hepatitis A Virus Hepatitis B Virus Hepatitis C Virus HIV-1, HIV-2 West Nile Virus Bebesiosis Malaria Trypanosoma Cruzi

10 CMV Infection Neonates who at increased risk for post transfusion CMV related mortality and morbidity should be transfused with: Seronegative Component Leukoreduced blood products

11 These potential complications underscore the need to carefully evaluate a neonate's ability to deliver oxygen to tissues prior to ordering a nonemergent transfusion, and to document benefit following the transfusion

12 RBC TRANSFUSION INDICATIONS
It is often difficult to distinguish the neonate who is anemic and requires RBC transfusion from one who has adapted to a low hematocrit (Hct), and is best treated conservatively to avoid the associated risks of transfusion

13 Anemia occurs when the red blood cell (RBC) mass does not adequately meet the oxygen demands of the tissue Oxygen supply to the tissue is defined as the product of cardiac output and arterial oxygen content (1.34×Hgb×Sao2)+(0.003×Pao2)

14 Suggested Guideline for Red Blood Cell Replacement in high risk neonates
Acute Blood loss The need for transfusion in an infant with acute blood loss is generally dependent upon persistent clinical signs of inadequate oxygen delivery following intravascular volume restoration Chronic Blood Loss The need for RBC transfusion is, likewise, based upon clinical signs of inadequate oxygen delivery (increased resting heart rate, acidosis, poor growth, and apnea) and the degree of respiratory support needed by the infant

15 Acute blood loss Neonates with significant acute blood loss require immediate fluid resuscitation Term infants may tolerate perinatal blood loss up to one-third of their total blood volume Infants with a hemoglobin level ≥10 gm/dL following volume expansion usually have adequate oxygen delivery and generally only require iron supplementation to replace iron losses due to the hemorrhage.

16 Indications for a RBC transfusion in a term or preterm neonate following an acute blood loss include: >20 percent blood loss 10 to 20 percent blood with evidence of inadequate oxygen delivery, such as persistent acidosis Ongoing hemorrhage Consider the rate of blood loss before transfusion

17 Chronic Anemia Anemia of Prematurity NICU care and phlebotomy

18 Restrictive (low) versus liberal (high) target hematocrit (Hct) thresholds
The restrictive (low) transfusion thresholds compared with a liberal (high) threshold resulted in modest reductions in exposure to transfusions, and there were no differences in mortality, major morbidities, and serious neurodevelopmental impairment at 18 to 20 month corrected age

19 Chronic Blood Loss Restrictive (low) transfusion thresholds
Week 1 With respiratory support – 11.5 No respiratory support – 10 Week 2 With respiratory support – 10 No respiratory support – 8.5 Week 3 With respiratory support – 8.5 No respiratory support – 7.5

20 Chronic Blood Loss Restrictive (low) transfusion thresholds
For severe cardiopulmonary disease(Fio2>40%, MAP>8cm H20) Hematocrit <30% (Hgb 10) For moderate cardiopulmonary disease(Fio2<40%, MAP≤8cm H20) Hematocrit <25% (Hgb<8) For infants with anemia (Need to oxygen without pressure support) Hematocrit <25% (Hgb<8) with one or more of the following : HR>180/min, RR>60/min, pH<7.2, lactic acid>2.5meq/lit, weight gain<10gr/kg/day, major surgery within 72 hr For asymptomatic infants Hematocrit<18%(Hgb≤6) ) with an absolute reticulocyte <100,000/microL (<2 percent).

21 Suggested Guideline for Red Blood Cell Replacement in high risk neonates
For severe cardiopulmonary disease(Fio2>40%, MAP>8cm H20) Maintain hematocrit 40%- 45% For moderate cardiopulmonary disease(Fio2<40%, MAP≤8cm H20) Maintain hematocrit 30%- 40% For major surgery Maintain hematocrit 30%- 35% For infants with stable anemia Maintain hematocrit >20%-25%

22 Leukoreduced and irradiated red cells
Leukoreduction filters remove approximately 99.9 percent of white blood cells from PRBCs leukoreduction does not eliminate all lymphocytes and cannot prevent transfusion-associated-graft-versus-host disease (TA-GVHD) Irradiation prevents TA-GVHD in susceptible recipients The dose of radiation is not sufficient to kill viruses and irradiation does not provide a CMV-safe product Leukoreduced PRBCs should be used in all neonates CMV-seronegative PRBCs should be used Infants awaiting or undergoing transplantation Immunocompromised infants Preterm infants of CMV-seronegative mothers

23 Pretransfusion Testing, Dose and Administration
Blood group and type Wt (kg) X blood volume per kg X (Desired Hct - Observed Hct)/Hct PRBCs,10 to 20 mL/kg Over two to four hours

24 Platelet Transfusion Indication Pretransfusion testing Dose
<30000 for stable term and preterm infants <50000 for VLBW neonates within the first week of life, clinically unstable neonates and neonate with alloimmune thrombocytopenia in neonates prior to major surgery if the platelet count is <100,000/microL Pretransfusion testing ABO Compatible Dose 1EU/5-10kg Administration of 10 to 15 mL/kg of platelet suspension will increase the platelet count from 50,000 to 100,000/microL.

25 Fresh Frozen Plasma FFP is used primarily to treat acquired coagulation factor deficiencies ABO compatible ml/kg

26 Cryoprecipitate Transfusion
It is a useful product in infant who required higher concentration of factors 8, 13, vWF, or fibrinogen It is the treatment of choice for factor 13 deficiency, congenital afibrinogenemia, dysfibrinogenemia, and severe hypofibrinogenemia(<150mg/dl) associated with bleeding 1u/5kg

27 Intravenous Immunoglobulin
Useful in fetuses and neonates with Rh and ABO immune hemolytic disease mg/kg/2- 4hr IVIG should be considered in neonates with DAT- positive immune hyperbilirubinemia who are not responding to intensive phototherapy and whose TB concentration is approaching exchange transfusion

28 Granulocyte Transfusion
Granulocyte transfusion may be considered in neonates with qualitative neutrophil defects with severe bacterial or fungal infection ABO and Rh compatible, cross match Complications

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