1. Dr. Jyoti prajapati
Guided by
dr. S.S. Yadav

2. INTRODUCTION
 Blood transfusion is one of the oldest forms of
therapy.
 Critical care frequently requires the urgent use of
large numbers of blood component, often as a
lifesaving supportive measure
 Blood component transfusion plays a very
important role in modern transfusion.
 Through modern medical methods, many kinds
of blood components are separated from whole
blood.

3.  The routine separation of donor blood into
components and plasma fraction has made it
possible for blood banks to provide the specialized
blood products required for the support of
patients in multiple treatment modalities.
 The infusion of blood component is called
component transfusion or blood component
therapy.

4. TYPES
Blood- Fresh Whole Blood
Reconstituted whole blood
Blood Products
Cellular Components- Red Cell Concentrates
Platelet Concentrates
Granulocyte Concentrate
Plasma Components- Fresh Frozen plasma
Cryoprecipitate
Stored plasma
Plasma Derivatives- Albumin
Immunoglobulin
Coagulation Factors

5. Fresh Whole Blood
o
Light spin, C(within 8 hrs)
Packed Red Cells Platelet Rich Plasma
o
Heavy spin, C
Platelet Concentrate Fresh Plasma
o
Store at C Freeze(FFP)

6.  In some special cases, whole blood, usually in the
form of reconstituted whole blood, can be used.
 However, in most cases blood components are
preferred because each component has specific
optimal storage conditions and component therapy
maximizes the use of blood donations.

7. WHOLE BLOOD
 contains RBCs and plasma clotting factors.
 Few units are stored as whole blood.
 can be reconstituted from a unit of RBCs and FFP.
 stored at 1°C to 6°C and coagulation factors decay at
this temperature.
 should be no more than 5 to 7 days old.
 Platelets in are cleared rapidly following transfusion.
 reconstituted whole blood lacks significant quantities
of platelets
Indications.
 Exchange transfusions.
 Surgery
 Massive transfusion, trauma
 can be used as a substitute for blood components.

8. Packed Red Blood Cells (PRBCs)
 After plasma is separated from red cells by centrifugation
of 350 ml whole blood, the RBC component has a volume
of about 200 ml and Hct of about 80 %.
 The whole blood is spun to sediment out the RBCs, and
most of the plasma is removed by pushing it into a pre-
attached satellite bag.
 Genarally 100 to 110 mL of a nutrient additive solution is
added back to the packed RBCs, creating an “additive RBC”
product that has a final hematocrit of 55% to 60%.
 These solutions prolong the shelf life of the RBC product
from 21 days (packed RBCs in CPD) to 42 days (additive
RBCs).

9. Available forms of RCCs
The following forms of RCCs are available for the
treatment of anaemia.
 RBC concentrates.
 RBC concentrates deprived of the buffy coat.
 RBC concentrates with additive solutions.
 RBC concentrates deprived of the buffy coat and re
suspended in additive solutions.
 Washed RBC.
 Leucodepleted RBC.
 Frozen RBC.
 Apheretic RBC.
 Irradiated RBC.

10.  PRBCs are the most commonly used blood product
in neonatal transfusions.
 Red blood cells (RBCs) are transfused to increase
the oxygen-carrying capacity of the blood and, to
maintain satisfactory tissue oxygenation.
 Guidelines for RBC transfusions in children and
adolescents are similar to those for adults.

11.  Indications for transfusion of PRBCs are mainly
resolution of symptomatic anemia and for
improvement of tissue oxygenation.
 Tissue oxygenation depends on cardiac
output, oxygen saturation and hemoglobin
concentration.
 Once cardiac output and oxygen saturation are
optimal, tissue oxygenation can only be improved
by increasing the hemoglobin level.
 The guidelines for transfusion of PRBC vary
according to age, level of sickness and hematocrit.

12. Factors other than hemoglobin concentration to be
considered in the decision to transfuse RBCs
include:
(1) Patient's symptoms, signs, and functional
capacities,
(2) The presence of cardiorespiratory, vascular, and
central nervous system disease
(3) The cause and anticipated course of the anemia
(4) Alternative therapies, such as recombinant
human erythropoietin (EPO) therapy, which is
known to reduce the need for RBC transfusions
and to improve the overall condition of children
with chronic renal insufficiency and preterm
infants.

13. Blood component therapy in newborn
The total blood volume of neonates is small, although
the volume is higher per kg of body weight than that of
older children or adults. (85 ml/kg for full-term and 100
to 105 ml/kg for pre-term). .

14.  Blood transfusion in pre-term infants, is often given
for the anaemia of prematurity, associated with
delayed renal production of erythropoietin due to
decreased sensitivity to lower haematocrit levels.
 These neonates may require multiple
transfusions, increasing the risk of infectious
disease transmission, through multiple donor
exposures. alloimmunization
 Studies have shown that multiple transfusion from
multiple donor in preterms is associated with
increased risk of ROP and BPD.

15.  Stable neonates do not require RBC
transfusion, regardless of their blood hemoglobin
level, unless they exhibit clinical problems
attributable to anemia.
 symptomatic anemia causes
tachypnea, dyspnea, tachycardia, apnea and
bradycardia, feeding difficulties, and lethargy.
 However, anemia is only 1 of several possible
causes of these problems, and RBC transfusions
should only be given when clinical problems are
attributable to the anemia.

16. Measures to reduce multiple blood transfusions in preterm
infants
In preterm and sick neonates, needing multiple
transfusion , aliquots from a single donor can be
given as sequential transfusions.
This is done practically by reserving a bag of fresh
PRBC for up to 7 days for a newborn and
withdrawing small amounts required repeatedly
from that bag under laminar flow using a sterile
connecting device, into a fresh blood bag.
The PRBC bag is immediately resealed under the
laminar flow, and can be reused for withdrawing
similar small quantities of blood for up to 7 days.

17. Choosing the blood group for neonatal transfusions.
a.. Mother’s sample should be tested for blood group
and for any atypical red cell antibodies.
b. ABO compatibility.
Though ABO antigens may be expressed only
weakly on neonatal erythrocytes, neonate’s serum
may contain transplacentally acquired maternal
IgG anti-A and/or anti-B.

18. Choosing the blood group for neonatal transfusions.
c. Blood should be of newborn’s ABO and Rh group.
It should be compatible with any ABO or atypical
red cell antibody present in the maternal serum.
d. In exchange transfusions for hemolytic disease of
newborn-, blood transfused should be compatible
with mother’s serum.
If the mother’s and the baby’s blood groups are
the same, use Rh negative blood of baby’s ABO
group.
In case mother’s and baby’s blood group is not
compatible, use group O and Rh negative blood for

19. Volume and rate of transfusion:
 Volume of packed RBC = Blood volume (mL/kg)
x (desired - actual hematocrit)/ hematocrit of
transfused RBC
 If more volume is to be transfused, it should be
done in smaller aliquots.
 The dose is 5 to 20 mL/kg transfused at a rate of
approximately 5 mL/kg/hour.
 In chronic anemia and cardiovascular compromise
dose is 5ml/kg at the rate of 1-3ml/kg/hr.

20. It has been seen that transfusion with PRBC at a
dose of 20 mL/kg is well tolerated and results in an
overall decrease in number of transfusions
compared to transfusions done at 10 mL/kg in
preterm and VLBW infants.
 There is also a higher rise in hemoglobin with a
higher dose of PRBCs.
 in infants and newborn, one unit of RCC( 10 ml/kg)
increases Hb by 3g/dl.

21. Properties of RBC products used in neonatal
transfusion:
 RBCs should be freshly prepared and should not
be more than 7 days old.
 concerns with old RBCs are high 2, 3-DPG
concentration and higher tissue extraction of
oxygen, hyperkalemia, and a reduced RBC life
span.

22. Guidelines for packed red blood cells
transfusion thresholds for preterm neonates ( nnf protocol)
 Less than 28 days of age and
 1. Assisted ventilation with FiO2 more than 0.3: Hb 12.0
gm/dL or PCV less than 40%
 2. Assisted ventilation with FiO2 less than 0.3: Hb 11.0 g/dL
or PCV less than 35%
 3. CPAP: Hb less than 10 gm/dL or PCV less than 30%
 More than 28 days of age and
 1. Assisted ventilation: Hb less than 10 gm/dL or PCV less
than 30%
 2. CPAP: Hb less than 8 gm/dL or PCV less than 25%

23. Guidelines for packed red blood cells
transfusion thresholds for preterm neonates ( nnf protocol)
Any age, breathing spontaneously and
 1. On FiO2 more than 0.21: Hb less than 8 gm/dL
or PCV less than 25%
 2. On Room Air: Hb less than 7 gm/dL or PCV less
than 20%

24. INFANTS WITHIN THE FIRST 4 MO
OF LIFE
 Hemoglobin of <13.0 g/dL and severe pulmonary
disease
 Hemoglobin of <10.0 g/dL and moderate
pulmonary disease
 Hemoglobin of <13.0 g/dL and severe cardiac
disease
 Hemoglobin of <10.0 g/dL and major surgery
 Hemoglobin of <8.0 g/dL and symptomatic
anemia
nelson

25. CHILDREN AND ADOLESCENTS
 Acute loss of >25% at circulating blood volume
 Hemoglobin of <8.0 g/dL in the perioperative
period
 Hemoglobin of <13.0 g/dL and severe
cardiopulmonary disease
 Hemoglobin of <8.0 g/dL and symptomatic chronic
anemia
 Hemoglobin of <8.0 g/dL and marrow failure
(nelson)

26. Chronic Anaemia
 In anemias that are likely to be permanent, it is also
important to balance the detrimental effects of anemia
on growth and development vs the potential toxicity
associated with repeated transfusions.
 With chronic anemia, the decision to transfuse RBCs
should not be based solely on blood hemoglobin levels
because children compensate well and may be
asymptomatic despite low hemoglobin levels.
 Patients with iron-deficiency anemia are often treated
successfully with oral iron alone, even at hemoglobin
levels of <5 g/dL.

27. When to transfuse in chronic anaemia
Transfusion should be considered in a
asymptomatic child with a Hb level of less than
4 g/dL.
• Transfusion should be considered in a child
with a Hb level of less than 5 g/dL with clinical
signs of cardiac or respiratory distress .
Increases in heart rate or respiratory rate alone
may be normal compensatory mechanisms and
are not necessarily indications for transfusion.

28. .
• Blood is not generally recommended for children
with a Hb level between 4 and 5 g/dL who are
clinically stable.
 These children should be admitted for evaluation
and treatment of the cause of their anaemia and
should be monitored closely for changes in Hb
level and signs of decompensation.
 Treat the cause as infection , nutritional and mild
blood loss anaemia with specific therapeutic
agents as indicated (iron, folic acid, B12).

29.  Respiratory distress is unlikely to be due to chronic
anaemia if the Hb level is 5 g/dL or greater.
 Children with a Hb level of 5 g/dL or greater
should not be transfused indiscriminately, but the
cause of their anaemia should be investigated.
• Children should be transfused with 10 to 15 ml/kg
of PRBCs or 20 ml/kg of whole blood.
 Transfusions must be given slowly (over a 4 hour
period. At the rate of 2-3 ml/kg/hr.
 monitored closely to avoid volume overload.
 Diuretics should be used if the patient is in
congestive cardiac failure.

30. Congenital Anaemias
Children with congenital anaemias such as sickle cell diseases
Hb S/S, Hb S/C, Hb S/ -thalassaemia, like all other
children, should only be transfused when they develop
cardio-respiratory symptoms from severe anaemia.
The transfusion threshold in thalassaemia is generally 9–9.5
g/dL of Hb, in order to guarantee a balance between
inhibition of bone marrow erythropoiesis and iron overload
from transfusion therapy
In sickel cell anaemia Hb should be maintained at 10-12
gm/dl with <30% Hb S.
 Transfusion therapy is not normally indicated in patients
with Hb values > 7 g/dL
 consider hydroxyurea, erythrocytapheresis, stem cell
therapy.

31.  In children, the transfusion of RCC 5 mL/kg
increases the Hb concentration by about 1 g/dL.
 In the case of a lower than expected transfusion
yield, conditions causing the loss, sequestration or
destruction of RBCs should be looked for. Such
conditions include:
 - Occult bleeding;
 - Repeated blood sampling (particularly in children);
 - Hypersplenism;
 - Primary and secondary immunological causes;
 - Mechanical or other type of haemolysis.

32. Modifications of cellular blood component
About 70% of the blood products are filtered to
remove leukocytes (white blood cell) that fight
foreign material such as bacteria, viruses and
abnormal cells that may cause disease.
When leukocytes are present in donated blood, they
may not be tolerated by the pt receiving the blood
and cause some types of transfusion complications.

33. specifically treated RCCs
 RBC concentrates deprived of the buffy coat and
resuspended in additive solutions.
 Washed RBC.
 Leucodepleted RBC.
 Frozen RBC.
 Apheretic RBC.
 Irradiated RBC

34. 1. Leucodepleted/ Leucoreduced RCCs
Most plasma & 70-80% WBC(buffy coat) removed &100 ml of
Additive Solution added.
indications
 Prevention of febrile non-haemolytic transfusion
reactions (FNHTRs) caused by the presence of
antibodies to white blood cells:
 - patients with recurrent FNHTR;
 - patients who need prolonged transfusion support.
 Reduction of the incidence of CMV infections
 Reduction of the risk of rejection in candidates for
haematopoietic stem cell transplantation.
 Prevention of refractoriness to platelet transfusion.
 Intrauterine transfusions and transfusions to
premature babies, neonates, and infants up to 1 year.
 Candidates for renal transplantation.

35. Washed RCC
RBC washed with 1-2 L Normal Saline
Prevent febrile non hemolytic reactions.
Washing eliminates antibodies & other plasma
constituents
indication
 Patients with IgA deficiency .
 Prevention of allergic reactions not sensitive to
antihistamine drugs
 Post-transfusion febrile reactions, present even when
leucodepleted RBCs are used
 Paroxysmal nocturnul hemoglobinuria
 Patients with T activated cells by infections who
require transfusion

36. Irradiated RCCs
 Irradiation, at the dose of 25–50 Gy, is currently
the only method available for preventing
transfusion-related GvHD.
Frozen RCCs
 -Patients with complex immuno haematological
profiles in the absence of compatible donors

37. PLATELET TRANSFUSION
Thrombocytopenia is defined as platelet count less
than 1.5 lakh/cubic mm.
Presence of thrombocytopenia leads to an increase
in risk of bleeding.
Dysfunctional platelets in the presence of normal
platelet counts may also cause bleeding tendency.
Thrombocytopenia has been observed in 1–5% of
newborns at birth.
Severe thrombocytopenia defined as platelet count
of less than 50,000/cubic mm may occur in 0.1–
0.5% of newborns.

38.  In NICU, there is a higher incidence; with
thrombocytopenia being observed in up to 22–
35% of all babies admitted to NICUs and in up to
50% of those admitted to NICUs who require
intensive care.
 Significant proportions (20%) of these episodes of
thrombocytopenia are severe.
 Thus a large number of neonates are at risk for
bleeding disorders in NICU.

39.  Platelets are stored at 20°C to 24°C using
continuous gentle horizontal agitation in storage
bags specifically designed to permit O2 and CO2
exchange to optimize platelet quality.
 Types – SDP and RDP
 The storage time from collection to transfusion of
platelets (RDPs) is 5 days.
 SDPs can be stored for up to 7 days.
 thrombocytopenic patients transfusion therapy
with RCC is indicated to maintain the Htc around
30% and to reduce the risk of haemorrhage.

40. Recommandation for platelets use
 Platelets should never be filtered through a
micropore blood filter before transfusion.
 S’d be transfused as rapidly as pt can tolerate 1
unit/20 min.
 S’d be ABO compatible.
 The usual recommended dose of platelets for
neonates is 1 unit of platelets per 10 kg body
weight, which amounts to 5 mL/kg.
 The predicted rise in platelet count from a 5-
mL/kg dose would be 20 to 60,000/cubic mm.
 15 Doses of up to 10-20 ml/kg may be used in case
of severe thrombocytopenia.

41. Neonatal thrombocytopenia
 Immune thrombocytopenia:
a) Neonatal alloimmune thrombocytopenia
(NAIT)
b) Neonatal autoimmune thrombocytopenia
 Nonimmunologically mediated thrombocytopenia

42. Neonatal alloimmune thrombocytopenia (NAIT)
 The best choice of platelet transfusion is human platelet antigen
(HPA) compatible platelets, which are generally maternal
platelets, meticulously washed and irradiated.
 The aim is to maintain the platelet count above 30,000/ cubic
mm.
 HPA compatible platelets are not easily available.
 In the absence of immunologically compatible platelets, random
donor platelet transfusions may be an acceptable alternative, and
has been shown to increase platelet counts above 40,000/cubic
mm in most of the transfused patients.
 An alternative approach is the use of intravenous
immunoglobulin (IVIG) (1 g/kg/day on two consecutive days or
0.5 g/kg/day for four days), alone or in combination with random
donor platelet transfusion.

43. b. Neonatal autoimmune thrombocytopenia
 The goal is to keep the count above 30,000/cubic
mm.
 IVIG is given if counts are less than the acceptable
minimum at a dose of 1 g/kg/day on two
consecutive days.

44. Nonimmunologically mediated
thrombocytopenia
Low platelet count occurring at less than 72 hours of
age is caused most commonly by
placental insufficiency,
maternal PIH,
early onset sepsis (EOS), and
perinatal asphyxia.
EOS and asphyxia may, in particular, lead to severe
thrombocytopenia.

45. Thrombocytopenia occurring beyond the initial 72
hours is most commonly caused by sepsis and
necrotising enterocolitis.
Other infrequent causes include intrauterine
infections, metabolic errors and congenital defects
in platelet production.
Indications for platelet transfusion in nonimmune
thrombocytopenia depend on the level of sickness
of newborn

46. Indications for platelet transfusion in nonimmune
thrombocytopenia in newborn
1. Platelet count less than 30,000/cubic mm: transfuse all
neonates, even if asymptomatic
2. Platelet count 30,000 to 50,000/cubic mm: consider
transfusion in
a. Sick or bleeding newborns
b. ELBW or less than 1 week of age
c. Previous major bleeding tendency
d. Newborns with concurrent coagulopathy
e. Requiring surgery or exchange transfusion
3. Platelet count more than 50,000 to 99,000/cubic mm:
transfuse only if actively bleeding

48. INFANTS WITHIN THE FIRST 4 MO OF LIFE
 PLTs < 100 × 109/L and bleeding
 PLTs < 50 × 109/L and an invasive procedure
 PLTs < 20 × 109/L and clinically stable
 PLTs < 100 × 109/L and clinically unstable
 PLTs at any count, but with PLT dysfunction plus
bleeding or an invasive procedure

49. CHILDREN AND ADOLESCENTS
 PLTs < 50 × 109/L and bleeding
 PLTs < 50 × 109/L and an invasive procedure
 PLTs < 20 × 109/L and marrow failure with
hemorrhagic risk factors
 PLTs < 10 × 109/L and marrow failure without
hemorrhagic risk factors
 PLTs at any count, but with PLT dysfunction plus
bleeding or an invasive procedure

50. Plasma-Derived Blood Components
FFP
Plasma separated from a unit of whole blood and
frozen within 8 h of collection is designated fresh
frozen plasma (FFP) .
 The usual volume of FFP is about 225 ml. FFP
supplies all of the constituents of fresh
plasma, including the labile coagulation
factors, albumin and globulin.
Plasma contains about 1 unit/mL of each of the
coagulation factors

51.  Labile coagulation factors, like factors V and
VIII, are not stable in plasma stored for prolonged
periods at 1–6° C; therefore plasma is usually
stored frozen at –18° C or lower.
 It contains about 87% of factor VIII present at the
time of collection but decay later.
 FFP must be ABO-compatible with the recipient’s
red blood cells.

52. Recommendations for use of Fresh frozen plasma
 Fresh frozen plasma is indicated for correction of
coagulation abnormalities and for correction of
microvascular bleeding when prothrombin time
and partial thromboplastin time are greater than
1.5 times the mid-range normal reference value.
 FFP should not be used when a coagulopathy can
be corrected with vitamin K.
 Volume of FFP to be transfused is usually 10–20
mL/kg
 10-15ml/kg dose increses factor activity by 20-30%.

53.  FFP should not be used when a coagulopathy can
be corrected with vitamin K.
 Volume of FFP to be transfused is usually 10–20
mL/kg
 10-15ml/kg dose increses factor activity by 20-30%.

54. Indications
 Severe clotting deficiency (including DIC) with
bleeding
 Severe clotting deficiency in a neonate undergoing
an invasive procedure
 Vitamin K deficiency with bleeding
 Dilutional coagulopathy with bleeding
 Severe anticoagulant protein deficiency
 Reconstitution of packed RBC for exchange
transfusion

55. FFPFFP has newborn been used for a variety of
use in traditionally
reasons, including volume replacement, treatment
of DIC, treatment of a bleeding neonate for
prevention of intraventricular hemorrhage, and in
sepsis.
 It has not been shown to have any survival
benefits in most of these conditions and currently
the only valid indications for transfusing FFP in a
newborn include
 1. Disseminated intravascular coagulopathy
 2. Vitamin K deficiency bleeding
 3. Inherited deficiencies of coagulation factors

56. Cryoprecipitate:
It is prepared from FFP by thawing at 2 – 4C.
Undissolved cryoprecipitate is collected by
centrifugation and supernatant plasma is aseptically
expressed into a satellite bag.
contains approximately 100 u of factor VIII and von
Willebrand factor,
75 u of factor XIII, and
250mg of fibrinogen in a volume of 20 ml.
It is stored at a temperature of -20o C or below.

57.  Dose of cryoprecipitate in treating
hypofibrinogenemia is an initial infusion of 10
bags, followed by 10 to 20 bags q8h or as necessary to
keep the fibrinogen level above 100 mg/dl.
 1-2 unit /kg cryo increases fibrinogen by 1g /dl.
 Volume of cryoprecipitate to be transfused is usually 5
mL/kg.
 The half-life of fibrinogen is about 4d.

58. Recommendations for Factor VIII/
cryoprecipitate:
 Congenital factor deficiencies are rare in the
neonatal period.
 While treating bleeding neonates, cryoprecipitate
is often considered an alternative to FFP because
of its small volume.
 cryoprecipitate contains only factors VIII, XIII and
fibrinogen and is not effective in treating the more
extensive clotting factor deficiencies.

59. Indications for use of cryoprecipitate:
 Afibrinogenemia,
 Von Willebrand factor deficiency, congenital
antithrombin III deficiency, hemophilia.
 Protein C deficiency and protein S deficiency when
specific factor replacement is not available.
 It is also used for reconstitution of blood for
exchange transfusion.

60. Granulocyte Transfusions
Granulocyte concentrates are collected from single
donors by use of a blood cell separator.
10
Each concentrate contains approximately 10
granulocytes which are about one tenth of the
normal adult,s daily production and that is far
fewer than that of an infected patient.
Granulocytes are fragile and may be stored no
longer than 24 h.
 The usual concentrate contains about 250 ml of
plasma and has a Hct of 15 to 20 percent.
ABO compatibility is necessary.

61.  GTX is recommended only when infections are
clearly unresponsive to antimicrobial
drugs, infected children with sustained bone
marrow failure (malignant neoplasms resistant to
treatment, aplastic anemia, and hematopoietic
progenitor cell transplant recipients) may benefit
when GTX is added to antibiotics.
 The use of GTX for bacterial sepsis unresponsive to
antibiotics in patients with severe neutropenia
(<0.5 × 109/L) is supported by many controlled
studies .

62. Guidelines for Pediatric Granulocyte
Transfusions
CHILDREN AND ADOLESCENTS
 Neutrophils of <0.5 × 109/L and bacterial
infection unresponsive to appropriate
antimicrobial therapy
 Qualitative neutrophil defect and infection
(bacterial or fungal) unresponsive to appropriate
antimicrobial therapy
INFANTS WITHIN THE FIRST 4 MO OF LIFE
Neutrophils of <3.0 × 109/L (1st wk of life) or <1.0 ×
109/L (thereafter) and fulminant bacterial infection

63. Human serum albumin
HSA is comprised of 96 percent albumin and 4
percent α-and β –globulin.
Dose is 0.5- 2 gm/kg
indications –
 Hypovolemic shock,
 Hypotension associated with hypovolemia in
liver failure or protein-losing conditions,
 Inadequate diuresis in fluid overloaded
hypoproteinemic patients.

64. INTRAVENOUS IMMUNOGLOBULIN
 IVIG is a concentrated purified solution of
immunoglobulins with stabilizers such as sucrose.
 contain >90% immunoglobulin G (IgG) with small
amounts of immunoglobulin M (IgM) and
immunoglobulin A (IgA)
Indications.
 Alloimmune disorders
 Congental immunodeficiency syndromes.
 Hyperimmune immunoglobulins- several infectious
agents including Varicella-zoster virus and respiratory
syncytial virus, rabies.
 Severe sepsis
Dosing ==of 500 to 900 mg/kg.

65. TRANSFUSION ASSOCIATED RISKS
Blood transfusion reactions may be broadly classified as
 1. Infectious
 2. Non-infectious
a. Acute i. Immunologic
ii. Non-immunologic
b. Delayed

66. Infectious complications
Viral infections: (HIV), hepatitis B and C viruses
(HBV & HCV), and cytomegalovirus (CMV).
contaminate platelet products more commonly than
RBC products
 Risk of post transfusion hepatitis B/C in India is
about 10% in adults despite routine testing
because of low viraemia and mutant strain
undetectable by routine ELISA.

67. Bacterial infections: Platelets are at a higher risk
 The highest fatality is seen with gram-negative
bacteria.
 febrile nonhemolytic reaction post
transfusion, bacterial contamination always remains a
possibility.
 higher rise in temperature than other febrile
transfusion reactions.
Parasites: Plasmodium, trypanosome
and may occur in spite of blood bag testing, as the
screening tests for malaria are insensitive

68. Prions : Variant Cruetzfold Jacob Disease ( v CJD)
is an established complication of blood transfusion
and has been reported since 2004.
 incubation period of approximately 6.5 years.
 no easy test as yet to detect the presence of prions.
 not very clear whether leukoreduction prevents
transmission of CJD.
 Restricted transfusions and avoidance of
transfusions unless essential, are the only ways
currently to prevent transmission

69. Noninfectious complications:
immune mediated and nonimmune mediated reactions, and as
acute and delayed complications.
Acute immune mediated reactions
1. Immune mediated hemolysis
 rare in neonates
 Newborns do not form red blood cell (RBC) antibodies; all
antibodies present are maternal in origin.
 Newborns must be screened for maternal RBC antibodies,
including ABO antibodies, if non-O RBCs are to be given as the
first transfusion.
 If the initial results are negative, no further testing is needed
for the initial 4 postnatal months.

70.  Infants are at a higher risk of passive immune hemolysis
 direct antiglobulin (Coombs) test may confirm the
presence of an antibody on the RBC surface.
 Smaller quantities of ABO-incompatible plasma (less than
5 mL/kg) are generally well tolerated.
 Newborns do not manifest the usual symptoms of
hemolysis.
 An acute hemolytic event in newborns may be present as
increased pallor, presence of plasma free
hemoglobin, hemoglobinuria, increased serum potassium
levels, and acidosis.
Treatment is mainly supportive and involves maintenance of
blood pressure and perfusion with intravenous saline bolus
of 10 to 20 mL/kg along with forced diuresis with
furosemide

71. Symptoms and Signs of Acute Haemolytic Transfusion Reactions
General: - Fever, chills, flushing
- Nausea, vomiting
- Headache
- Pain at infusion site
- Back or loin pain
Cardiac/respiratory: - Chest pain
- Dyspnoea
- Hypotension
- Tachycardia
Renal: - Haemoglobinuria
- Oliguria
- Anuria
Haematological: - Anaemia
Disseminated Intravascular Coagulation
Thrombocytopenia

72. 2. TRALI (Transfusion related acute lung injury): It
refers to noncardiogenic pulmonary edema
complicating transfusion therapy
 It has been associated with all plasma-containing
blood products.
 anti-HLA and/or anti-granulocyte antibodies.
 The most common symptoms associated with TRALI
are dyspnea, cough, and fever, associated with hypo- or
hypertension.
 initial 6 hours after transfusion.
 Treatment is mainly supportive in this self-limiting
condition.

73. 3Febrile nonhemolytic transfusion reactions
(FNHTR)
4. Allergic reactions
 rare occurrence in newborns
 presence of preformed immunoglobulin E
 mild, and respond to antihistaminics.
 Severe anaphylactic reactions are rare ..

74. Acute non immune reactions
1. Fluid overload: Neonates are at increased risk of
fluid overload from transfusion because the
volume of the blood component issued may
exceed the volume that may be transfused safely
into neonates.
 There is no role for routine use of furosemide while
transfusing newborns.

75. 2. Metabolic complications: These complications
occur with large volume of transfusions like
exchange transfusions.
a) Hyperkalemia: large volume transfusions,old
RCC,
b) Hypoglycemia: Blood stored in CPD blood has a
high content of glucose leading to a rebound rise in
insulin release 1-2 hours after transfusion.
 This may lead to hypoglycaemia and routine
monitoring is necessary, particularly after
exchange transfusion, after 2 and 6 hours

76. c) Hypocalcemia and hypomagnesemia are caused by
binding of these ions by citrate present in CPD
blood.
d) Acid- base derangements:
 Metabolism of citrate in CPD leads to late
metabolic alkalosis.
 Metabolic acidosis in sick babies who cannot
metabolize citrate.

77. Delayed complications
1. Alloimmunization: Alloimmunization is an uncommon
occurrence before the age of 4 months, and is caused by
transfusion of blood products with are mismatched for highly
immunogenic antigens like Rh.
2. Transfusion associated graft versus host disease (TA-
GVHD): Newborns are at risk for TA-GVHD if they have received
intrauterine transfusions, exchange transfusions, or are very
small, or immunocompromised.
 Unchecked donor T cell proliferation is the cause of TA-GVHD
 it can be effectively prevented by leukoreduction of the
transfused blood products in at risk patients
3 .Iron ovrload
4. ROP and CLD in preterms

78. Summary
 Blood should be used only to relieve clinical signs of
cardiac and respiratory distress in severely anaemic
patients, in order to achieve haemodynamic stability.
 Blood should NOT be used to correct anaemia.
 Most patients with chronic anaemia have nutritional
and/or mild blood loss anaemia responds rapidly and
effectively to specific therapies.
 These patients have normal blood volumes and the
transfusion of whole blood may cause circulatory
overload, with harmful effects.
 Thetransfusion of PRBCs should be carried out
slowly, with careful monitoring of the patient.

79.  Transfusion in the newborn requires selection of
appropriate donor, measures to minimize donor
exposure and prevent graft versus host disease and
transmission of Cytomegalovirus.
• Component therapy rather than whole blood
transfusion, is appropriate in most situations.
• A clear cut policy of cut-offs for transfusions in
different situations helps reduce unnecessary
exposure to blood products.
• Transfusion triggers should be based on underlying
disease, age and general condition of the neonate.

80.  RBC Tx remains an essential part of management of
high risk preterms
 Focus on prevention of anaemia, donor restriction
and restriction of no of TX
 Avoid unnecessary Tx.
 RESTRICT no of transfusions,
 Avoid unnecessary sampling, Micro-techniques,
noninvasive monitoring, rhEPO
 Blood transfusion is not a cure for anaemia. Blood
transfusion is used to relieve the clinical signs of
cardiac or respiratory distress, but the underlying
cause of the anaemia still needs to be investigated and
treated.