National Survey of Neonatal Transfusion Practices: II. Blood Component Therapy

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

Neonatal transfusion practices during 1989 of 452 institutions involved in transfusing infants were surveyed by questionnaire. Most respondents (77%) transfused fresh frozen plasma appropriately (ie, primarily to treat coagulation disorders). However, 11% stated that their most frequent use of fresh frozen plasma was solely to treat hypovolemia, a practice generally not recommended. Seventy-eight percent of respondents transfused platelets to treat bleeding infants with blood platelet counts of less than 50 x 10⁹/L; 84% gave platelets to sick, premature neonates with counts of less than 50 x 10⁹/L whether or not bleeding was evident. Only 35% of respondents transfused granulocytes for neonatal sepsis; most institutions used buffy coats isolated from units of blood—a product readily available, but of questionable efficacy when compared with leukapheresis granulocytes. Ninety-three percent of respondents provided blood components with low risk of transmitting cytomegalovirus: components from seronegative donors were used by 84%, leukocyte-reduced products by 6%, and a combination by 10%. Thirteen percent of respondents gave gamma-irradiated blood components to all and 46% gave them to some neonates to prevent graft vs host disease. Forty-one percent did not routinely irradiate. Ten percent of respondents used leukocyte reduction instead of gamma irradiation to prevent graft vs host disease, a practice currently not advocated. Thus, national transfusion practices for neonates are variable, controversial, and, occasionally, other than those usually recommended. Additional research and educational efforts are needed to ensure optimal transfusion therapy.

Key Words: neonatal transfusions • fresh frozen plasma • granulocyte transfusions • platelet transfusions • cytomegalovirus • graft vs host disease

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

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