In this section
The following recommendations
apply to neonates at the Royal Children's Hospital
Transfusion of blood products to neonates should comply with
hospital procedures in regard to pretransfusion
administration and management
and reporting of adverse effects.
Red cells may be required for neonatal transfusion for surgery
or resuscitation when large volumes are required.
Haemoglobin thresholds vary
depending on neonatal age and oxygen requirement at time of transfusion. The
values listed below outline haemoglobin thresholds in neonates taking into
consideration age and oxygen requirements:
In all cases, a haemoglobin result from an FBE is preferable to a blood gas haemoglobin.
*Note: If an infant is undergoing massive or rapid transfusion,
the use of older red cell units may be associated with
hyperkalaemia. If this clinical circumstance is anticipated request
red cells which are <= 5 days old at the time of
In neonates typical transfusion
dose is 10–20mL/kg (where the upper end of the range
applies to severe anaemia, expected ongoing risk
factors or concurrent bleeding).
Exchange transfusion is generally carried out for
hyperbilirubinaemia and/or anaemia, usually due to haemolytic
disease of the newborn (HDN) or prematurity.
The Blood Service produces a red cell product specifically for neonatal
exchange transfusion. This red cell product has
the following specifications:
Whole blood is no longer available from the blood service
Pedipaks should be used for all red cell top-up transfusions in
infants. Pedipaks are available as a stock item in group O Positive
and O Negative. They are CMV negative and leucocyte depleted. One blood donation is split into four equal volumes
(approximately 50ml). The use of pedipaks enables
us to minimise patient exposure to multiple
Pedipaks should be requested at the time of blood request.
Please indicate volume of transfusion.
The neonatal extended expiry (ASBT protocol) enables
us to omit repeated blood group antibody screening prior to transfusion for infants during the
first 4 months of life. This protocol recognises that the development of
antibodies to red cell antigens is very uncommon in the first 4 months of life. The protocol reduces the requirement for repeated sampling of blood.
Any infant less than 4 months of age who is likely to require
more than one transfusion.
The laboratory will make an assessment of suitability according
to established criteria;
If accepted, the laboratory will issue a report indicating that
a further sample will not be required for any further blood group and antibody screens until a date
when the baby is 4 months from birth.
If an infant is discharged and readmitted, they must requalify
for neonatal extended expiry protocol.
Any infants with a positive DAT and/or significant maternal red
cell antibody shall be excluded.
Order neonatal extended expiry in EMR.
Indicate any previous transfusion
history, in particular intrauterine transfusion, or transfusion outside RCH.
Indicate transferring hospital.
Once an infant is accepted on the
neonatal extended expiry, further samples are not required for pretransfusion
testing. Blood can be ordered as per regular ordering procedure in EMR.
The platelet products suitable for neonatal transfusion are
single units prepared from whole blood donations or apheresis
collections split into small packs for paediatric use. All platelet
products prepared in Victoria are leucocyte depleted and irradiated.
Fresh Frozen Plasma must be compatible with the infants red cell
antigens, ie should be group identical or group AB.
The guidelines of the UK Transfusion Services (2002) state that
blood transfused in the first year of life should be
cytomegalovirus (CMV) seronegative. Other authorities state that
products that have been leucocyte depleted to less than 5 x
106/unit have a significant reduction in the risk of CMV
transmission. Transfusion recipients at greatest risk of CMV
transmission are fetuses, infants weighing less than 1.5kg,
immunodeficient patients and stem cell transplant recipients.
Some clinicians may prefer CMV seronegative components for patients
considered to be particularly susceptible to severe CMV infection
(patients with cellular immunodeficiency and stem cell transplant
recipients). When CMV seronegative products are not available,
leucocyte depleted products are an acceptable alternative. Since
60-70% of the adult population are CMV seropositive, CMV
seronegative products may not always be available.
Cellular blood products may be irradiated to reduce the risk of
transfusion-associated graft versus host disease (ta-GVHD).
All neonates at the Royal Children's Hospital.
Established clinical guidelines for irradiation of cellular
blood products in the fetus and neonate include:
The 'universal' irradiation policy at RCH is a practical
alternative to selecting appropriate patients, and relies on the
fact that RCH has a blood irradiator on site.
Cellular products: Red Blood Cells, Platelets.
All platelet products used within RCH are irradiated before
issue by Australian Red Cross Blood Service (ARCBS).
Irradiation does not alter expiry time for platelet products.
Red Cell products will be irradiated by the RCH blood bank
immediately prior to issue. The irradiation process takes
approximately 5 minutes. If there is a need for immediate
transfusion for an exsanguinating infant, emergency blood release
of non-irradiated blood is available. Do not delay transfusion in
Irradiation of blood products
Some infants with NEC and/or sepsis develop T activation of red
cells. T activation occurs through the action of bacterial
neuraminidases and results in exposure of crypt antigens on the red
cell surface. T activation was detected in the laboratory by a
lectin test, however, this test is no longer available . Infants
with NEC and sepsis can develop haemolysis. There are some reports
of transfusion exacerbating haemolysis in these very sick infants.
Since all adult plasma contains anti-T which could potentially
exacerbate haemolysis, some experts advocate special transfusion
support for these infants. Practice in this area is varied because
of the lack of definitive studies.
It is reasonable to avoid plasma exposure by requesting washed
red cell products in an infant with significant haemolysis. It is
reasonable to avoid using FFP/platelet transfusion unless there is
significant coagulopathy/thrombocytopenia in the presence of
bleeding and/or need for an invasive procedure. Urgent transfusion
should not be delayed while waiting for special blood
Transfusion support should be discussed with the consultant on an
Blood samples (maternal,
cord) received with NETS transfers will be accepted by The RCH
Core Laboratory when the following criteria are met:
Note that the request
form should indicate the type of specimen i.e. maternal
or cord sample
Forward samples to the laboratory
immediately where they will be stored appropriately and used as