3. Attach, aseptically, in sequence

a. Platelet concentrate or bag aliquot

b. Platelet administration set, including filter

c. Three-way stopcock

d. Transfusion syringe

4. Draw volume of platelets for transfusion and tubing

dead space into syringe. Clear air bubbles.

5. Remove syringe from three-way stopcock and attach to

connecting tubing.

6. Establish IV access. If infant is at risk for hypoglycemia

with interruption of continuous glucose source, start

new IV or monitor closely throughout infusion.

7. Clear IV of glucose solution with 1 mL or more of normal saline.

8. Attach connecting tubing and syringe to IV line.

9. Monitor patient’s vital signs.

10. Infuse platelets over 1- to 2-hour period, faster if tolerated by infant.

11. After infusion is complete, flush IV line with 1 mL of

normal saline before restarting glucose solution.

12. Determine survival time of transfused platelets by

obtaining platelet counts at 1 and/or 24 hours if concern for platelet refractoriness.

F. Complications

1. Accentuated hemolysis in sensitized but indirect antiglobulin test–negative ABO setup

2. Rh sensitization in Rh-negative recipient (34)

3. Volume overload

4. Allergic reactions, including hypotension

310 Section VIII ■ Transfusions

5. Transfusion-related lung injury (TRALI) (35)

6. Increased morbidity in NEC (36)

Complications discussed in more detail in

“Complications of Blood Products” section.

Granulocyte Transfusions

A. Indications

1. Granulocyte transfusions are used infrequently because

of improvements in antimicrobial medications, supportive care, and the occasional use of granulocyte- and

granulocyte/macrophage-stimulating factors.

2. Granulocyte transfusion may be considered in the following conditions; however, reduction in morbidity or mortality have not been confirmed in randomized trials (37).

a. Neonates <14 days old with bacterial sepsis and

absolute neutrophil count (ANC) (+ band count)

<3 × 109

/L, and older neonates with bacterial sepsis

and ANC (+ band count) <0.5 × 109

/L

b. Neutropenic neonates with fungal disease not

responsive to standard antifungal therapy.

B. Equipment and Technique

1. Granulocyte concentrates for neonatal use are prepared

by automated granulocytapheresis, and should contain

1 to 2 × 109

 neutrophils/kg in a volume of 10- to 15-mL/

kg. Steroid- and G-CSF-mobilized donor preferred.

2. Daily transfusions may be necessary until there is clinical improvement and evidence of recovery of neutrophil counts.

3. Component must be ABO- and Rh-compatible with

recipient, and cross-match–compatible.

4. Product should be irradiated, CMV-negative, and

infused as soon as possible after collection.

5. The product should not be refrigerated or warmed

above room temperature.

6. Standard 120- to 170-mm filters should be used for

infusion; microaggregate and LD filters must be

avoided.