Transfusion Guidelines
University of
Washington Division of Neonatology |
| Authors |
Created
03/30/99 |
Reviewed
03/30/99 |
Revised
3/30/99 |
|
Rationale
The following guidelines were formed by consensus of the neonatologists of the University of Washington Division of Neonatology. As empirical data regarding the optimum methods for managing anemia in infants are largely lacking, these guidelines are based primarily on theoretical and practical considerations. For this reason they are meant to serve as a reference to decrease unnecessary transfusions, rather than as a rigid protocol. As in the past, any thoughtful variations from these guidelines are encouraged.
Transfuse for hematocrit < 20%:
In an asymptomatic infant, if reticulocytes <100,000/ul.
Transfuse for hematocrit < 30% if:
- requires oxygen, < 35% FiO2
- on CPAP or IMV with mean airway pressure < 6 cm H20
- significant apnea and bradycardia while on methylxanthines (>9 episodes in 12 hours or 2 episodes in 24 hours requiring mask and bag ventilation)
- if heart rate > 180 beats/min or respiratory rate > 80/min and persists for 24 h
- weight gain < 10g/d over 4 days despite adequate calories
- sepsis
Transfuse for hematocrit < 35% if:
- requires oxygen, > 35% FiO2
- intubated on CPAP or IMV with mean airway pressure > 6 cm H20
Selected References
- F. J. Bednarek, S. Weisberger, D. K. Richardson, I. D. Frantz, B. Shah, and L. P. Rubin. Variations in blood transfusions among newborn intensive care units. SNAP II Study Group. J.Pediatr. 133 (5):601-607, 1998.
- S. A. Ringer, D. K. Richardson, R. A. Sacher, M. Keszler, and W. H. Churchill. Variations in transfusion practice in neonatal intensive care. Pediatrics 101 (2):194-200, 1998.
- W. G. Keyes, P. K. Donohue, J. L. Spivak, M. D. Jones, Jr., and F. A. Oski. Assessing the need for transfusion of premature infants and role of hematocrit, clinical signs, and erythropoietin level. Pediatrics 84 (3):412-417, 1989.
- K. M. Shannon, J. F. Keith, III, W. C. Mentzer, R. A. Ehrenkranz, M. S. Brown, J. A. Widness, C. A. Gleason, E. M. Bifano, D. D. Millard, C. B. Davis, D. K. Stevenson, D. C. Alverson, C. F. Simmons, M. Brim, R. I. Abels, and R. H. Phibbs. Recombinant human erythropoietin stimulates erythropoiesis and reduces erythrocyte transfusions in very low birth weight preterm infants. Pediatrics 95 (1):1-8, 1995.
Authors
This document was created and prepared for this Web site by:
|
