BLOOD COMPONENT THERAPY in the Newborn

1
BLOOD COMPONENT THERAPY in the Newborn

• Amit Ray
• Kolkata

2

• Of all patient groups preterm infants are one of
  the most frequently transfused
• Unique features of neonates immature immune
  system, difficult to cope with metabolic load,
  presence of mat Abs

3
Current trends

• More aware of risks of Tx AIDS epidemic other
  infections e.g. CMV, HBV, HCV, Parvo, malaria
  ROP TAGVHD
• Window period HBsAg 59 days
• Scarce commodity
• Hence RESTRICT no of transfusions, avoid
  unnecessary sampling, Micro-techniques,
  noninvasive monitoring, rhEPO

4
RBC Tx in newborn- Guidelines

• 1 PCV lt 20, low Retics, symptoms
• 2 PCV lt 30, with
• lt35 Hbox O2, nasal O2, CPAP or IMV (map 6), gt6
  apnea/brady in12h req bagging, HR gt180 x 24h, RR
  gt80 x 24h
• 3 PCVlt35 with gt35 O2 by Hbox or CPAP/IMV
• (map 6-8)
• 4 PCV lt45 with cong cyan ht ds

5
RBC Tx

• Small vol Tx with Packed RBC concentrate (PCV
  70-90)
• Preservative CPD, AS-3
• Infuse over 2-4 h, Dose 15 ml/kg
• 2,3 DPG gt70 in 1st 5 days

6
TAGVHD

• Immune response mounted by donor T-cells against
  host tissues
• fatal syndromewasting, dermatitis, hepatitis,
  GIT sympt., marrow suppression, high fever by 4
  days of tx
• Fresh blood lt 96 h old a risk factor
• Irradiation of blood from immediate relatives
  imp for large vol Tx only

7
FFP

• Used to replace coagulation factors
• 10-15 ml/kg
• may repeat 12-24hrly
• NOT indicated for vol expansion

8
Indications for FFP

• HDN with sign. Haemorrhage
• Isolated factor deficiency
• Replacement in AT III, prot C or S def.
• DIC
• Bleeding following massive transfusion
• Therapeutic plasma xchange in TTP

9
Platelet concentrate

• From centrifugation of whole blood
• Final conc 85 (50-70 lakh/cu.mm)
• Some white cells inevitably present
• 1 unit of random donor raises plt count to
  gt1lakh/cu.mm, by infusing 5-10 ml/kg of std
  platelet conc.
• Plt shd be Rh ABO specific

10
Guidelines for Plt Tx

• lt 30k in term NB with failure of production
• lt 50k in stable prem with active bleed or
  invasive procedure in DIC pt
• lt1 lakh in sick prem with active bleed or
  invasive procedure in DIC pt
• Active bleed in pt of Plt Quality defect
• Unexplained xcessive bleed in cardio-pulm bypass
  
• ECMO with plt lt 1lakh or with bleeding

11
Granulocyte Tx

• Possible role in sepsis in conjunction with
  antibiotics
• Optimal use yet to be established
• Only useful if obtained by leukopheresis
• Must be irradiated

12
Whole blood

• Rarely required
• Ind. blood loss, cardiac surgery, exchange Tx

13
Conclusions

• RBC Tx remains an essential part of mge of hi
  risk prems
• Focus on prev of anaemia, donor restriction and
  restriction of no of TX
• Be aware of the potential for harm esp
  infections. Avoid unnecessary Tx.