B. Contraindications

1. None absolute

2. Exert caution in patient with:

a. Volume overload

b. Congestive heart failure

c. T-activation

d. Increased risk for NEC (especially extremely lowbirthweight infants)

C. Technique

1. Determine total amount of blood needed.

a. Calculate volume of blood for transfusion. Most

infants are transfused 10 to 15 mL/kg of RBCs,

which will increase the hemoglobin by 3 g/dL.

b. RBC volume required: [EBV × (Hct desired – Hct

observed)] Hct of RBC unit

(1) Hct is hematocrit

(2) EBV is the estimated patient’s blood volume 80

to 85 mL/kg in full-term infants and approximately 100 to 120 mL/kg in preterm infants

(3) RBC units collected in citrate-phosphatedextrose-adenine (CPDA-1) have a Hct of

approximately 70%, RBCs in extended-storage

AP solutions (AS-1) have a Hct ≤60%

2. Include volume of blood needed for dead space of tubing, filter, pump mechanism (varies from system to system; may be as much as 30 mL).

3. Obtain blood product (see Appendix C).

a. Several studies have documented the safety of using

PRBCs stored in extended-storage anticoagulant

preservative (AP) solutions to outdate (20–22).

b. Avoid use of RBCs stored in extended-storage AP

solutions for massive transfusions, unless the additive is removed by inverted storage or centrifugation;

risks of hyperosmolality, hyperglycemia, hypernatremia, hyperkalemia, hyperphosphatemia are postulated (21,23,24).

Table 43.2

Guidelines for Transfusion of

RBCs in Patients <4 Months

of Age

Clinical Status Target Hematocrit

For severe cardiopulmonary disease (requiring

mechanical ventilation with FiO2 >0.35)

>40%–45%

For moderate cardiopulmonary disease >30%–35%

For major surgery >30%–35%

For infants with stable anemia with unexplained apnea/bradycardia, tachycardia, or

poor growth

>20%–25%

Modified from Fasano RM, Luban NL. Blood Component Therapy for the

Neonate. In: Martin R, Fanaroff A, eds. Fanaroff & Martin’s Neonatal-Perinatal

Medicine. 9th ed. St. Louis: Elsevier; 2010:1360; Strauss RG. How I transfuse red

blood cells and platelets to infants with the anemia and thrombocytopenia of prematurity. Transfusion. 2008;48:209.

Definitions for level of severity of cardiopulmonary disease may be defined individually by institution.