Blood
Components Available for Red Cell Transfusion of Neonates
New
Zealand Blood Service currently provides two types of red cell component for use
in the neonatal period.
All
blood components provided by NZBS are leucodepleted at source. Statistical
process control is used to ensure that greater than 99% of components will have
a level of <5 x 106 WBC per unit (95% confidence).
Whole Blood Plasma Reduced Leucocyte Depleted
Specification
Units less than 5 days old
Group O Rh(D) negative
Plasma reduced whole blood with a haematocrit 0.6-0.70
CMV antibody negative
Clinical uses
Exchange
transfusion
Massive
transfusion episodes (≥ 1 blood volume in 24 hours)
A
detailed datasheet on this component is available on the NZBS website (www.nzblood.co.nz)
Red
Cells Resuspended Neonatal Leucocyte Depleted
These are
produced by splitting of suitable red cell units using sterile systems to
provide 4-6 aliquots from each donor unit. For infants likely to require
repeated transfusion single units can be dedicated to an individual baby to
reduce donor exposure.
Specification
Units
up to 35 days old
Group
O Rh (D) negative
Red
cells resuspended in optimal additive solution (SAG-M)
Haematocrit
0.50-0.70
CMV
antibody negative
Clinical
uses
Top
up transfusion of neonates (10 – 20 ml/kg)
A
detailed datasheet on this component is available on the NZBS website (www.nzblood.co.nz)
Special
Considerations When Transfusion Neonates
a. Cytomegalovirus
Infection
Infants
weighing less than 1.5kg, those with immunodeficiency and stem cell
transplant recipients are at greatest risk of transfusion transmitted CMV
disease. These infants should receive cellular blood components that are CMV
antibody negative.
Cellular
blood components produced for neonatal use by NZBS are normally CMV antibody
negative. In certain specific settings this may not however be possible.
When
CMV antibody negative components are not available then the transfusion of
leucodepleted components is an acceptable alternative
b. Irradiation
of Blood Components
Detailed
Guidelines on irradiation of blood components produced by the Australian and
New Zealand Society for Blood transfusion (ANZSBT) can be obtained on the
NZBS website (www.nzblood.co.nz)
Irradiation
is used to reduce the risk of Transfusion associated Graft versus Host
disease (TA-GvHD).
Irradiated
components are required for
Infants
with known or suspected immunodeficiency disorders
Infants
who have received intrauterine transfusions
Infants
transfused with directed donations (from family relatives)
Exchange
transfusion where the requirement to irradiate will not unduly delay
transfusion.
Routine
irradiation of cellular blood components for neonates outside of the above is
not required by current international guidelines.
c. Hyperkalemia
Potassium
leaches out of red cells during liquid storage. The potassium level in donated
blood therefore increases with age. Clinically this is not normally a problem
since the potassium rapidly re-enters the red cells following transfusion. The
rate of potassium leakage increases significantly in red cell components that
have been irradiated.
In
certain clinical settings however the increased potassium level may be
important. In such settings fresh blood (less than 5 days old) should be used.
This applies to
Exchange
transfusion
Massive
transfusion during surgery of following blood loss
