ANALYSIS OF TRANSFUSION OF PACKED RED BLOOD CELLS IN NEONATES IN NEONATAL INTENSIVE CARE UNIT
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Keywords
Neonates, Packed red cells, neonatal intensive care unit, transfusion therapy
Abstract
Background: The small blood volume and immature organ systems in the neonate necessitate special approaches in neonatal transfusion practice. Blood components in the form of packed red cells are mainstay of treatment in neonatal intensive care units. Due to increasing demand of transfusion therapy in neonatal age group, it is of prime importance to ensure the quality, accurate dose and well-defined indication of the component transfused.
Aim: To analyze the transfusion practices of neonates in neonatal intensive care unit.
Materials and methods: The study was conducted in the department of IHBT, GMC Jammu done over a period of 1 year. This is prospective observational study comprising of 76 neonates who were admitted in neonatal intensive care unit and received transfusion therapy in the form of packed cells. Results: Out of 76 neonates, 45 (59.21%) neonates were females and 31 (40.79%) neonates were males. 62 (81.58%) were preterm and 14 (18.42%) were term neonates. 5 neonates (6.58%) were extremely low birth weight, 11 (14.47%) were Very low birth weight, 46 (60.53%) were low birth weight and 14 (18.42%) were normal birth weight. Small volume transfusions were given mainly comprising of 18 (25.71%) who received volume less than 15 ml, 40 (57.14%) received 16-25 ml and 12 (17.14%) were transfused with volume more than 25 ml of PRBC. Shock was found to be the major indication for transfusion in 30 neonates (39.47%) followed by anemia (25%), bleeding (18.42%), sepsis (11.84%) and hypoxic ischemic encephalopathy (1.32%). 31 neonates (41.33%) received single transfusion and 44 neonates (58.67%) received multiple transfusion. Donor exposure is calculated based on the feasibility of multiple aliquots from single donor unit of PRBC. 72.6% neonates were exposed to 1 donor, 21.92% neonates were being exposed to 2 donors and 5.48% neonates were exposed to 3 donors.
Conclusion: Packed red cells are the major component transfused to preterm neonates being admitted in neonatal intensive care unit. Aliquoting from a single donor unit is an important step in the direction of providing safe and effective blood component therapy to neonates.
References
2. Vecchio A D, Franco C, Petrillo F, D’Amato G. Neonatal Transfusion Practice: When do Neonates Need Red Blood Cells or Platelets? Am J Perinatol 2016;33(11):1079-84.
3. Strauss RG. Managing the anemia of prematurity. Red blood cell transfusions versus recombinant erythropoietin. Transfus Med Rev 2001;15(3):213-23.
4. Dogra K, Kaur G, Basu S, Chawla D. Red Cell Transfusion Practices in Neonatal Intensive Care Unit: An Experience from Tertiary Care Centre. Indian J Hematol Blood Transfus 2018;34(4):671–76.
5. Strauss RG (2001) Managing the anemia of prematurity. Red blood cell transfusions versus recombinant erythropoietin. Transfus Med Rev 15:213–223.
6. Kirpalani H, Whyte RK, Anderson C, Asztalos EV, Heddle N, Blajhman MA et al (2006) The premature infants in need of transfusion (PINT) study: a randomised, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr 149:301–307.
7. Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ et al (2005) Randomised trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 115:1685–1691.
8. Stockman JA, Graeber JE, Clark DA, McClellan K, Garcia JF, Kavey RE et al (1984) Anemia of prematurity: determinants of the erythropoietin response. J Pediatr 105:786–792.
9. Fustolo-Gunnink SF, Roehr CC, Lieberman L, et al.. Platelet and red cell transfusions for neonates: lifesavers or Trojan horses? Expert Rev Hematol 2019;12:797–800.
10. Kirpalani H, Bell EF, Hintz SR, et al.. Higher or lower hemoglobin transfusion thresholds for preterm infants. N Engl J Med Overseas Ed 2020;383:2639–51.
11. Franz AR, Engel C, Bassler D, et al.. Effects of liberal vs restrictive transfusion thresholds on survival and neurocognitive outcomes in extremely low-birth-weight infants: the ETTNO randomized clinical trial. JAMA 2020;324:560–70.
12. Wang P, Wang X, Deng H, et al.. Restrictive versus liberal transfusion thresholds in very low birth weight infants: a systematic review with meta-analysis. PLoS One 2021;16:e0256810–4.
13. Giridharan J, Ramalingam GR. Study of blood component therapy in neonates. Int J Sci Res 2015;4(6):196–200.
14. Conti VS, Azzopardi E, Parascandalo R, Soler P, Montalto SA. Overview of blood transfusion policy in preterms on neonatal intensive unit care unit. Malta Med J 2013;25:46–50.
15. Arlettaz MR, Laura G, Ingab H, Dirk B, Christoph R. Neonatal red blood cell transfusion practices in Switzerland: national survey and review of international recommendations. Swiss Med Wkly 2020;150:w20178.
16. Portugal CAA, de Paiva AP, Feire ES, Chaoubah A, Duarte MC, Neto AEH. Transfusion practices in a neonatal intensive care unit in a city in Brazil. Rev Bras Hematol Hemoter 2014;36(4):245-49.
17. Hume H, Blanchette V, Strauss RG, Levy GJ. A Survey of Canadian Neonatal Blood Transfusion Practices. Transfus Sci 1997;18(1):71-80.
18. Santos AM, Guinsburg R, Prociany RS, Sadeck LS, Netto AA, Rugolo LM et al. Variability on red cell transfusion practices among Brazilian neonatal intensive care units. Transfusion 2010;50:150-59.
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Dr. Salve Sharma
Senior Resident, Department of Transfusion Medicine, GMC Jammu, India.
Dr. Kartik Samyal
Senior Resident, Department of Pediatrics, GMC Jammu, India.
Dr. Mitali Sharma
Assistant Professor, Department of Transfusion Medicine, GMC Jammu, India.
Dr. Vijay Sawhney
Associate Professor, Department of Transfusion Medicine, GMC Jammu, India.
Dr. Ambika Sambyal
MS Opthalmology, GMC Jammu, India.