National Survey of Neonatal Transfusion Practices: I. Red Blood Cell Therapy

¹ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Louisiana Blood Center, Shreveport
² From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Departments of Pathology and Pediatrics, University of Iowa College of Medicine, and DeGowin Blood Center, University of Iowa Hospitals and Clinics, Iowa City
³ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Department of Pediatrics, Université de Montréal, and Hôpital Ste-Justine, Montreal, Canada
⁴ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Mid-South Regional Blood Center, Memphis, TN
⁵ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Office of Consultation and Research in Medical Education and Department of Biostatistics, University of Iowa College of Medicine
⁶ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Department of Pathology, The Ohio State University, and Transfusion Service, The Ohio State University Hospitals, Columbus
⁷ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Department of Pathology, Eastern Virginia Medical School, Norfolk, and Children's Hospital of the King's Daughters, St Louis, MO
⁸ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Departments of Pathology and Pediatrics, St Louis University College of Medicine, and Departments of Pathology and Laboratory Medicine, Cardinal Glennon Children's Hospital, St Louis, MO
⁹ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Immunohematology Division, Johns Hopkins Hospital, Baltimore, MD
¹⁰ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Department of Pediatrics, University of Toronto, and Hospital for Sick Children, Toronto, Canada
¹¹ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Departments of Pathology and Pediatrics, University of Nebraska Medical Center, Omaha
¹² From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
¹³ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and Departments of Medicine and Pediatrics, University of Tennessee, Memphis
¹⁴ From the Pediatric Hemotherapy Committee, American Assoiation of Blood Banks and National Office, American Association of Blood Banks, Bethesda, MD.

Neonatal blood component transfusion practices during 1989 were surveyed via a questionnaire developed by the Pediatric Hemotherapy Committee of the American Association of Blood Banks. Of 1790 questionnaires mailed, 452 were selected to form the database for this analysis because they were from institutions in which neonates were transfused. Nearly all institutions contained intensive care units directed by neonatologists and were involved in the management of high-risk infants. Results from institutions serving as the primary pediatric teaching hospital of a medical school were compared with those with no medical school affiliation. Thirty-six percent of primary pediatric teaching hospitals and 52% of hospitals with no medical school affiliation performed pretransfusion testing in excess of that required, resulting in additional blood loss in neonates. Sixty-six percent of primary pediatric teaching hospitals used fresh frozen plasma to adjust the hematocrit of red blood cell concentrates prior to transfusion (a practice increasing donor exposure), compared with only 29% of hospitals with no medical school affiliation. The usual indication for small-volume red blood cell transfusions in severely ill neonates was to maintain a desired hematocrit level, whereas for stable infants, red blood cell transfusions were given to treat symptomatic anemia, rather than to maintain a predetermined hematocrit. As found in 1985, neonatal transfusion practices in 1989 were variable. However, improvements have occurred since 1985 to suggest that further research and educational efforts may serve to promote even better neonatal transfusion therapy.

Key Words: neonatal transfusions • compatibility testing • red blood cells • directed donors • additive solutions

Submitted on July 9, 1992
Accepted on September 22, 1992

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