304 Section VIII ■ Transfusions

b. When transfused blood has elevated glucose concentration, expect rebound hypoglycemia in infants

with hyperinsulinism.

B. Pretransfusion Testing and Processing

1. Blood group and Rh type

a. Maternal ABO blood group and Rh type: Screen

maternal serum for atypical antibodies.

b. Baby’s ABO blood group and Rh type: Screen baby’s

serum for atypical antibodies if maternal blood is

unavailable.

c. Cord blood may be used for initial testing.

d. Baby’s blood group is determined from the red cells

alone, because the corresponding anti-A and anti-B

isoagglutinins are usually weak or absent in neonatal serum.

2. Cross-matching

a. Compatible blood may be low-anti-A, anti-B titer

group O Rh-negative blood or, blood of the infant’s

ABO group and Rh type (except in alloimmune

hemolytic disease of the newborn).

b. Conventional cross-match is not required if infant

<4 months old and no atypical antibodies are

detected.

c. Compatibility testing for repeated small-volume

transfusions is usually unnecessary because formation of alloantibodies is extremely rare in the first

4 months of life.

d. If antibody screen is indirect antiglobulin test (IAT)-

positive in mother or baby

(1) Serologic investigation to identify antibody(ies)

is necessary.

(2) Full compatibility testing is required.

(3) If anti-A or anti-B detected in infant, infant

should receive RBCs lacking A or B antigen until

antibody screen is negative.

e. If infant has received large volumes of plasma or

platelets, passive acquisition of antibodies may occur;

cross-matching is recommended.

f. If directed donor blood from a parent is used, crossmatching is required.

3. Specially processed products

a. Transfusion-transmitted disease testing with all

donor collections (see “Complications” section)

b. Cytomegalovirus (CMV)-seronegative or thirdgeneration leukodepleted (LD) blood is recommended for infants with birthweight ≤1,200 g born

to seronegative mothers or those with unknown

serostatus (3).

c. Use of universal LD and/or CMV seronegative

products is institution-specific (4).

4. Irradiation to prevent transfusion-associated graftversus-host disease (TA-GVHD)

a. Whole blood, PRBCs, previously frozen RBCs,

granulocyte and platelet concentrates, and fresh

plasma have been implicated in TA-GVHD; LD

products have also been implicated.

b. Clinical indications for irradiated blood components are listed in Table 43.1.

c. Some institutions provide irradiated blood products

to all neonates to avoid TA-GVHD in patients with

undiagnosed immunodeficiency.

C. Equipment

1. Blood product (see Appendix C)

2. Cardiorespiratory monitor

3. Blood: All blood and blood components must be filtered immediately prior to transfusion despite prestorage LD. Many transfusion services supply RBCs and

occasionally platelets and cryoprecipitate, prefiltered to

the neonatal intensive care unit (NICU).