Red blood cell transfusion in preterm neonates: current perspectives

Figures & data

Table 1 Markers of transfusion needs in neonates

Anemia: hemoglobin (Hb)/hematocrit (Ht) values in relation to the reference ranges of Hb or Ht at different postnatal ages.

Reticulocyte counts <100,000/μL.

Clinical status of the newborn, particularly in the presence of severe cardiopulmonary diseases, or of symptoms of anemia suggesting inadequate tissue oxygenation, such as increase in oxygen requirement, tachycardia, apnea, and poor weight gain.

Hemodynamic changes detected by echocardiography.

Peripheral fractional oxygen extraction, or splanchnic-cerebral oxygenation ratio as measured by near infrared spectroscopy. Spectroscopic noninvasive measurement of hemoglobin.

Regional cerebral oximetry.

High concentrations of vascular endothelial growth factor as an indicator of insufficient oxygen delivery to tissues.

Table 2 How to reduce neonatal transfusion needs

Implement transfusional guidelines.

Delay cord clamping for at least 30 seconds from birth to reduce the need for transfusion and facilitate early hemodynamic stabilization of VLBW infants. Cord milking may be an effective alternative.

Use residual cord blood for initial laboratory investigations.

The possible role for autologous RBC transfusions by collection, processing and storage of umbilical cord blood is under evaluation.

Reduce phlebotomy losses by the use of microsampling and the judicious utilization of laboratory evaluations.

Use multiple transfusions from the same unit to reduce the donor exposure.

Ensure the most favorable nutrition with an adequate protein intake that is an important factor in stimulation erythropoiesis, and the optimal supplementation of iron, folic acid and vitamins.

Erythropoietin treatment remains controversial.