blood component in neonatal transfusion...

Sianny Herawati

Departemen Patologi Klinik Fakultas Kedokteran

Universitas Udayana / RSUP Sanglah Denpasar

BLOOD COMPONENT IN NEONATAL TRANSFUSION PRACTICE

1

INTRODUCTION

Transfusion practice in neonates differs from adults

Physiologic changes during transition from fetus to adolescent

Blood volume

Hematologic norms

Immune system maturity

Physiologic response to hypovolemia and hypoxia

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Complexity of neonatal transfusion practices

INTRODUCTION

3

most neonatal transfusion are given to very low birth weight (VLBW) infants

Advances in neonatology → permit survival of extremely premature infants

INTRODUCTION

Pemakaian komponen darah BDRS Sanglah periode Januari – Desember 2018

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Komponen Jumlahpemakaian pada

neonatus

Total seluruhpemakaian

% pemakaianpada

neonatus

PRC 429 19.341 2.22

TC 218 10.554 2.07

FFP 121 1.381 8.76

Cryoprecipitate

75 195 38.46

0

5

10

15

20

25

30

35

40

PRC TC FFP Cryoprecipitate

2.22 2.07

8.76

38.46

% pemakaian pada neonatus

NEONATAL TRANSFUSION

PRACTICE

Neonatal transfusion practice: transfusion practice during newborn period (birth to 4 months)

Patients younger than 4 months →

small blood/plasma volumes and

immature organ system function

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6


PRACTICE

Physiologic Anemia of Infancy

Decrease erythropoietin

(EPO) → diminished red cell production

Decreased survival of

fetal red cells

Increasing blood volume due to rapid

growth

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PRACTICE

Consideration for neonatal transfusion

Body size and blood volume

Erythropoietic response and

therapy

Cold stress

Immunologic status

Immature metabolic pathways

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BLOOD COMPONENT IN NEONATAL TRANSFUSION PRACTICE

Red blood cell

Platelet concentrate

Fresh Frozen Plasma (FFP)

Cryoprecipitate

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PRACTICE

Blo

od

co

mp

on

en

t sp

eci

fica

tio

n

Fresh, less than 7 days old

O-negative or compatible with mother and infant

CMV-negative or leukocyte reduced

Irradiated

Hemoglobin S-negative for hypoxic newborns

NEONATAL RED BLOOD CELL TRANSFUSION

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acute blood loss of >10% blood volume

hemoglobin < 8 g/dL in a stable newborn with symptoms of anemia (apnea, bradycardia, tachycardia, decreased vigor, poor weight gain)

hemoglobin < 12 g/dL in an infant with respiratory distress syndrome or congenital heart disease

Transfusion thresholds for RBCs

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PRACTICE

Anemia in the first 24 hours Hb 12 g/dl (Hct 0,36)

Cumulative blood loss in 1 week in neonate requiring intensive care

10% blood volume

Neonates receiving intensive care Hb 12 g/dl

Acute blood loss 10% blood volume

Chronic oxygen dependency Hb 11 g/dl

Late anemia, stable infant Hb 7 g/dl

NEONATAL RED BLOOD CELL TRANSFUSION

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Small volume

neonatal red cell transfusion

Large volume

neonatal red cell transfusion

Small volume transfusion (< 20 ml/kg)

Small volume aliquot:

To limit donor exposures

Prevent circulatory overload

Potentially decrease donor related risks

Multiple pack system

Repeated small volume top up red cell transfusion→ commonly in preterm babies → to replace losses from repeated blood testing

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PRACTICE

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PRACTICE

Methods for preparing small aliquots for transfusion

Transfer from collection bag to satellite bag/transfer bag

Blood can be withdrawn from collection bag using injection site coupler and needle and syringe or a

sterile docking device and syringe.

TRANSFUSION ADMINISTRATION

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Pedi bag prepared from a single unit of RBC

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PRACTICE

Large volume neonatal red cell transfusion

Equivalent to single circulating blood volume ( ± 80 ml/kg)

Mainly used in neonatal cardiac surgery, exchange transfusion

Less than 5 days from donation

Irradiated

CMV seronegative

PLATELET TRANSFUSION

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Neonatal platelet transfusion

Majority given as prophylaxis

given at 5 -10 ml/kg

single donor apheresis is preferred than whole blood source

ABO matched, RhD matched, CMV negative

Should not contain clinically significant red cell antibodies.oBe HPA compatible in infants with allo-immune thrombocytopeniaoBe irradiated if appropriate

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PLATELET TRANSFUSION

Transfusion guidelines for platelets in neonates and older children

PLASMA TRANSFUSION

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FFP Transfusion

• FFP 10 – 15 ml/kg, expected increase all factor activity levels by 15 – 20%

• Containing fibrinogen, f. VIII, f.XIII, vWF and fibronectin

• ABO compatible, free of clinically significant antibodies

Cryoprecipitate transfusion

• FFP thawing at 2-4⁰C → undissolved precipitate is collected by centrifugation and supernatant plasma is aseptically expressed into a satellite bag.

• Contains 80 to 100 U F.VIII, 300 mg fibrinogen and varying amounts of factor XIII.

PLASMA TRANSFUSION

Cryoprecipitate

Indication cryoprecipitate:

to treat decreased or dysfunctional fibrinogen (congenital or acquired) or

factor XIII deficiency

ABO compatible cryoprecipitate is preferred

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Dosing of small volumes in neonatal patients

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PRACTICE

Component Dose Expected increment

Red blood cells 10 – 15 ml/kg Hb increase 2 – 3 g/dl

Fresh frozen plasma

10 – 15 ml/kg 15-20% rise in factor levels (assuming 100% recovery)

Platelets ( WB derived or apheresis

5 – 10 ml/kg or 1 WBD unit/10 kg

50.000/ul rise in platelet count (assuming 100% recovery)

CryoprecipitatedAHF

1 – 2 units/10 kg 60-100 mg/dl rise in fibrinogen (assuming 100% recovery)

AABB, 19TH ED

CONCLUSION

Neonatal transfusion (birth - 4 months) differ from adult

Various treatment thresholds and guidelines used in neonatal transfusion practice from different countries

Special requirement for blood component in neonatal transfusion

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THANK YOU

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blood component in neonatal transfusion...

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