Multiple transfusion guidelines have been included in the recent literature
and can be easily implemented clinically [2,3,5] Most of these continue to use a
tiered approach to transfusion depending upon the requirement for
cardiopulmonary support. None of these guidelines have been compared in a
prospective trial and many rely upon clinical expertise. Currently, no national
consensus exists. A sample guideline is listed below:
Transfuse with PRBC’s if:
- HCT < 35% and intubated (or on CPAP > 8cm H20) with FiO2 > 0.35
- HCT < 30% and intubated (or on CPAP) with FiO2 < 0.35
o Undergoing surgery
o Poor weight gain for one week (< 10gm/day)
o Significant apnea or bradycardia requiring intervention - HCT < 20% if asymptomatic with low reticulocyte count
All units will be single donor, CMV negative
Irradiated blood products will be used in the following circumstances:
o Birthweight less than 1500 grams
o Exchange transfusion
o Directed donor of relative’s blood
o Transfusions to neonates who have received intrauterine
transfusionsErythropoietin in the Neonate