In this section
Transfusion of blood products to neonates should comply with
hospital procedures in regard to pretransfusion
administration and management
and reporting of adverse effects.
neonates will commonly receive small, top up transfusions of 10 – 20ml/kg to
treat anaemia of prematurity.
may also receive large volume transfusions; for example, exchange transfusion
for the treatment of haemolytic disease of the newborn and cardiopulmonary
bypass pump priming for cardiac surgery and extra-corporeal life support
Haemoglobin (Hb) thresholds vary depending on
neonatal post-natal age, oxygen requirements and respiratory support.
The values listed below outline Hb thresholds in preterm
neonates taking into consideration age and oxygen requirements:
No respiratory support
In general, a Hb result from an FBE is preferable to a blood gas Hb.
*Note: If an infant is undergoing a large-volume transfusion (exchange transfusion or ECLS), the use of older red cell units may be associated with hyperkalaemia. Request red cells which are 5 days old.
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).
Current Hb (g/L)
Transfusion of 10mL/kg
Transfusion of 15mL/kg
Transfusion of 20 mL/kg
Very preterm neonate with estimated blood volume 100 mL/kg
Term neonate with estimated blood volume 80 mL/kg
Exchange transfusion is generally carried out for
hyperbilirubinaemia and/or anaemia, usually due to haemolytic
disease of the fetus/newborn (HDN) or prematurity.
The Australian Red Cross Blood Service produces a red cell product specifically for neonatal
exchange transfusion. This red cell product has
the following specifications:
Commence transfusion within 30 minutes of product receipt and
complete transfusion within 4 hours of spiking pack.
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.
Administer via the Baxter
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.
Administer via the Baxter Neonatal Set
Platelet count (x10^9/L)
Clinical situation to trigger platelet transfusion in neonates
<25 - 30
term or preterm infant with asymptomatic thrombocytopenia and no bleeding
30 - 50
preterm infant with thrombocytopenia
or preterm infant with symptomatic thrombocytopenia and minor bleeding,
coagulopathy or prior to surgery.
or preterm infant with symptomatic thrombocytopenia and major bleeding or
requiring major surgery (e.g. neurosurgery)
Fresh Frozen Plasma must be compatible with the infants red cell
antigens, ie should be group identical or group AB.
Administer via the Baxter Neonatal
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.
infant less than 4 months of age who is likely to require more than one
laboratory will make an assessment of suitability according to established
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.
an infant is discharged and readmitted, they must requalify for neonatal
extended expiry protocol.
infants with a positive DAT and/or significant maternal red cell antibody shall
neonatal extended expiry in EMR.
any previous transfusion history, in particular intrauterine transfusion, or
transfusion outside RCH and indicate the transferring hospital.
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 Australian and New Zealand Society of Blood
Transfusion, Guidelines for Transfusion and Immunohaematology Laboratory
Practice, November 2016 provides guidance on the use of CMV seronegative blood
components. Their guidance is that CMV seronegative cellular blood components
should be used in intrauterine transfusions and neonates (up to 28 days post
expected date of delivery).
CMV seronegative products are not available, leucocyte depleted products are an
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
severe haemolytic transfusion reactions have been reported in neonates or
infants receiving red blood cell or FFP transfusions containing anti-T
antibodies. The T-antigen may be exposed on the neonatal RBC surface by neuraminidase-producing
bacteria such as Clostridium species and are often in association
with necrotising enterocolitis (NEC). T activation may
be detected in the laboratory by a lectin test, however, this test is no longer
available. 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
It is reasonable to avoid plasma
exposure by requesting washed red cell products in an infant with significant
haemolysis. All non-essential transfusions of FFP and
platelets should be avoided. Urgent transfusion should not be delayed while waiting
for special blood products.
Transfusion support should be discussed with the consultant on an individual
Blood samples (maternal,
cord) received with NETS transfers will be accepted by The RCH
Core Laboratory when the following criteria are met:
Note: the request
form should indicate the type of specimen i.e. maternal
or cord sample
Forward samples to the laboratory
immediately for processing.