TRANSFUSION OF PRBCs

Indications for Transfusion During the First Week of Life

• anemia
• hypovolemia/hypotension
• replace blood loss/phlebotomy

Indications for Transfusion After the First Week of Life

• Hgb <8 or Hct <24% and otherwise asymptomatic
• Hgb <10 or Hct <31% and any of the following:

• requiring any supplemental O2 (including intermittent need)
• apnea/bradycardia episodes requiring intervention
• HR >180BPM or RR >80BPM sustained over 24 hrs
• weight gain <10g/d x 4 days on >100Kcal/kg/d
• having scheduled surgery

• Hgb <11 or Hct <33% and any of the following:

• requiring >0.05lpm O2
• IMV/CPAP

NOTE: Lasix does not have to be given after a routine transfusion.

Irradiated blood should be used when:

• there is a suspicion of immunodeficiency (DiGeorge Syndrome, absent thymus, aortic arch abnormality, family history, etc.)
• the infant has received in utero transfusions, and is to receive a double volume exchange transfusion
• the blood is from a 1° family member (directed donor blood)

Acellular blood components (FFP and cryoprecipitate) do not need to be irradiated

"Blood out" (i.e., blood taken by phlebotomy) should not be routinely monitored after the first week of life, and, after the first week would only be replaced at the attending's discretion.

PLATELET TRANSFUSION

Platelet transfusions should be given as 10cc/kg of unspun (not volume reduced) platelet concentrate. This amount should theoretically raise the platelet count by 50-100,000/cu mm. Volume reduced platelets should only be ordered after consulting with the attending neonatologist.

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