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Ross M. Fasano

Wendy M. Paul

Transfusion of Blood and

Blood Products

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Overview

Blood Products Utilized in Neonates

A. Red blood cells (RBCs)

B. Whole or reconstituted whole blood

C. Platelet concentrates derived from whole blood or

plateletpheresis

D. Fresh frozen plasma (FFP) or frozen thawed plasma

E. Cryoprecipitate

F. Granulocyte concentrates derived from granulocytapheresis

Sources of Blood Products

A. Banked donor blood

B. Directed donor transfusions

C. Autologous fetal blood transfusions

Indications, requirements, and transfusion techniques differ

for each procedure and component. Simple transfusions

are discussed in this chapter. Exchange transfusions are discussed in Chapter 44. Complications common to all blood

products are listed later in this chapter.

A. Precautions (1)

1. Whenever possible, obtain informed consent prior to

transfusions, delineating risks, benefits, and alternatives

to transfusion.

2. Limit use of transfusions to justified indications.

3. Select blood product appropriate for infant’s condition.

4. Confirm with proper identifiers at bedside that blood

product is for correct patient. Maintain all records relevant to collection, preparation, transfusion, and clinical outcome.

5. Avoid excessive transfusion volume or rate unless acute

blood loss or shock dictates faster transfusion.

6. Store blood and blood products appropriately. Freezing

and lysis may occur if RBCs are stored in unmonitored

refrigerators.

a. Use blood bank refrigerator for storage of RBCs,

whole blood, thawed FFP, and thawed cryoprecipitate.

b. Temperature should be controlled at 1°C to 6°C

with constant temperature monitors and alarm

systems.

c. Refrigerator should be quality-controlled at least daily.

d. Designated for blood products only

e. Store platelets at 20°C to 24°C with continuous agitation.

7. RBCs and whole blood should be out of refrigeration

for <4 hours to minimize risk of bacterial contamination and RBC hemolysis.

8. Use approved blood-warming devices for RBCs and

whole blood. Syringes for aliquots must not be warmed

in water baths because of the risk of contamination.

9. Stop transfusion or slow rate if baby manifests any

adverse side effects.

a. Tachycardia, bradycardia, or arrhythmia

b. Tachypnea

c. Systolic blood pressure increases of >15 mm Hg,

unless this is the desired effect

d. Temperature above 38°C and/or increase in temperature of ≥1°C

e. Hyperglycemia or hypoglycemia

f. Cyanosis

g. Skin rash, hives, or flushing

h. Hematuria/hemoglobinuria

i. Hyperkalemia

10. Transfuse RBCs cautiously in infants with incipient or

existing cardiac failure (2).

a. Monitor heart rate, blood pressure, and peripheral

perfusion.

b. Consider partial exchange transfusion

(1) With hemoglobin level <5 to 7 g/dL

(2) With cord hemoglobin <10 g/dL

11. Prevent fluctuations in glucose during RBC transfusion

a. In infants weighing <1,200 g or in other unstable

infants, to prevent hypoglycemia

(1) Do not discontinue parenteral glucose administration.

(2) Establish separate IV line for blood administration.