Chapter 43 ■ Transfusion of Blood and Blood Products 311

1. Possible increased risk of transmitting infectious disease

because directed donors are often first-time or infrequent donors with no track record of safety, unlike

established volunteer donors, whose screening tests are

negative repeatedly.

2. Possibility of serologic incompatibility between the

recipient baby and the family donors.

a. Maternal plasma may contain alloantibodies directed

against paternal RBC, leukocyte, platelet, and HLA

antigens, which may result in significant hemolytic,

thrombocytopenic, or pulmonary reactions (41).

b. Paternal blood cells may express antigens to which

the neonate may have been passively immunized by

transplacental transfer of maternal antibodies.

c. Routine pretransfusion testing may not detect these

serologic incompatibilities.

3. Although biologic parents may be interested in donating for their infants, many are likely to be ineligible for

medical or serologic reasons.

B. Precautions

1. Directed donations must be screened as stringently as

volunteer donations.

2. If maternal RBCs or platelets are transfused, they

should be given as washed cells or should be plasma

reduced and irradiated.

3. Fathers and paternal blood relatives should preferably

not serve as donors for blood components containing

cellular elements (RBCs, platelets, or granulocytes); if

their use is unavoidable, a full antiglobulin cross-match

should be performed to detect incompatibilities.

4. All blood components obtained from first- or seconddegree relatives should be irradiated prior to transfusion

of the neonate to prevent TA-GVHD.

Autologous Fetal Blood Transfusions

The placenta contains 75 to 125 mL of blood at birth

depending on the gestational age of the infant. Autologous

transfusion in an infant can occur by collection, storage,

and reinfusion of autologous cord blood, or by delaying

cord clamping, a successful variation of autologous transfusion. Both maneuvers potentially provide a substantial volume of fetal blood for the neonate, eliminating the potential risks of transfusion transmitted diseases and TA-GVHD

(42). Protocols for proper collection of autologous cord

blood with appropriate anticoagulation, without bacterial

contamination, are still being refined for these indications.

A. Indications

1. Autologous cord blood is a convenient source of autologous RBCs for elective transfusion to preterm infants.

2. Delivery room resuscitation of infants with shock and

profound anemia, when O Rh-negative RBCs are not

immediately available. Delaying cord clamping has

been shown to instantly increase RBC mass and circulating blood volume, while decreasing the immediate

need of RBC transfusions and possibly the incidence of

intraventricular hemorrhage in the preterm infant

(43–45).

3. Source of cord blood for freezing for hematopoietic

reconstitution.

B. Contraindications

1. Maternal infection

2. Chorioamnionitis

3. Sepsis

4. Hepatitis, HIV

5. Prolonged rupture of membranes >24 hours

C. Complications

1. Bacterial sepsis from contaminated collection (46).

2. Insufficient collection volumes from infants <1,000 g.

3. Over-/undercollection for volume of anticoagulant

used