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Products / Services
Paediatric Transfusion Products
The clinical indications for transfusion in neonates and
infants may differ from those for adults, as infants are
more susceptible to some of the harmful effects of transfusion.
For the purpose of these guidelines, neonates are considered
to be babies within 4 weeks of their normal gestational
age. Infants are babies within the first year of life.
Most neonatal paediatric transfusions are small volume,
given to replace the blood losses of investigative sampling
or to alleviate the anaemia of prematurity. Larger transfusions
are needed for replacement during surgery or pathological
blood loss. Replacement in excess of blood volume may occur
during cardiac bypass surgery or total blood volume exchange.
Only blood that has been donated by voluntary donors and
subjected to stringent testing may be transfused. The practice
of the "walk-in donor" and collection of small
amounts of blood from selected special panels of donors
is no longer condoned. Donations by relatives have not been
shown to be microbiologically safer than that from the general
donor population and are not encouraged. Under certain circumstances,
blood from the mother may be used.
All blood donated from relatives must be irradiated prior
to transfusion to prevent "Graft versus Host"
Disease.
Testing
- During the first 4 months of life the pretransfusion
testing differs from adults in that, provided there are
no atypical antibodies in the maternal or infant's serum,
and the direct antiglobulin test is negative, the traditional
crossmatch is not necessary. However, the ABO and Rh group
should be reconfirmed prior to all transfusions.
- For infants older then 4 months the compatibility
testing procedures should be the same as for adults.
Pretransfusion testing for Neonates
- ABO and Rh group.
- Preferably samples from the mother and
neonate.
- Screen for the presence of atypical antibodies.
- Conventional crossmatch not necessary if
no antibodies present.
- Several small volume transfusions ("top
ups") from the same donor can be given to neonates
in the first 4 months of life. There is no need for further
crossmatching but each small volume transfusion must be
taken from new unopened red cell daughter pack. (See "Limited
Donor Exposure Programme" at the end of this chapter).
Other considerations
- The age of the unit does not matter for
small volumes such as top-up transfusions. For larger
volume transfusions such as exchange transfusions or resuscitation
of an actively bleeding infant, blood up to 5 days old
may be given without causing any metabolic complication
due to potassium or reduced 2,3 DPG.
- Potential hazards include hypocalcaemia
(citrate toxicity), particularly when whole blood is transfused,
hyperkalaemia, rebound hypoglycaemia, CMV infection, GvHD,
transfusion overload and haemolytic transfusion reactions
in infants with necrotising enterocolitis.
Indications for Red Cell Transfusion
Top-up transfusion
- Consider for any symptomatic neonate whose
haemoglobin is <10 g/dl.
- Neonates requiring supplemental oxygen
should be maintained at a higher haemoglobin concentration.
- The rate of transfusion should not exceed
5 ml/kg/h and for no longer than 5 hours. This is to minimise
the risk of bacterial proliferation which may occur as
a result of the blood warming to room temperature.
Exchange transfusion
- Exchange transfusions are mainly indicated
in the treatment of alloimmune haemolytic disease of the
new born. The object of the transfusion in this instance
is to remove Rhesus (D) red cells and reduce bilirubin
levels and maternally derived antibody. The bilirubin
level at which an exchange transfusion is indicated varies
according to the weight of the baby although under no
circumstances should the bilirubin concentration exceed
a concentration of 340 ?g/l. Note that in pre-term babies
the threshold is considerably lower and specialist paediatric
advice should be taken.
- Blood for exchange transfusion may be plasma
reduced to haematocrit between 0.5 and 0.6.
- The age of blood for exchange transfusion
should be within 120 hours (5 days) from collection.
- Blood should be warmed only during rapid
transfusion and during exchange transfusion. Only approved
and properly maintained blood warming equipment should
be used.
Treatment of Hypovolaemic Shock
- Initial treatment in adults is usually
carried out with crystalloid solution. However, in paediatric
patients, the initial replacement fluid recommended is
4-5% albumin solution. FFP should not be used unless there
are co-existing coagulation abnormalities.
- Indications for Platelets and Fresh Frozen
Plasma.
-The usual adult guidelines pertain to paediatric patients
for both products. However, thrombocytopenia is potentially
more hazardous in the neonate and a threshold of 30-50
x 109/l may justify transfusion. In general, one random
donor concentrate will constitute a single dose in an
infant, but in neonates, the volume may need to be reduced.
- In cases of neonatal alloimmune thrombocytopenia,
specialist advice should be sought. Emergency treatment
of unexpected and symptomatic cases can usually be provided
by transfusion of a unit of washed maternal platelets.
Specific Paediatric
products
The use of an adult unit of red cell concentrate or FFP
results in significant wastage since the volumes required
in paediatric patients are generally small. Many blood banks
have specific small volume red cell concentrate and FFP
units available on request.
Red cell concentrate
- Infant: 120 to 140 ml volume.
- Neonate: 80 ml volume.
FFP
Platelets
- Infant pooled random donor platelet: 40 to 60 ml volume
- Infant apheresis platelet: 40 to 60 ml volume
- Paediatric single donor platelet concentrate: 100 to 175 ml volume
The volume of blood component must be specifically
measured when transfusing neonates and small infants, and
not estimated.
Limited Donor Exposure Programme
Certain centres with busy paediatric units have arrangements
with the blood bank to ensure that any paediatric patient
with extended transfusion needs is included in their "limited
donor exposure" programme.
This programme ensures that the transfusion requirements
of one child are catered for by reserving units bled from
one donor for a specific infant. This ensures that the child
is exposed to only one or two sets of donor risk factors
and antigens during its treatment period.
Contact your Transfusion Service to find out what products
they have available.
Paediatric Product Price List
Please click here to refer to our price list
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