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Donor exposure in neonatal blood transfusion - time to change strategy?
  1. L Prasad,
  2. A Bhatty,
  3. S Banerjee
  1. Department of Neonatal Medicine, Singleton Hospital, ABM University Health Board, Swansea, UK

Abstract

Background Previous studies have recommended reserving 8 satellite packs (SP) for extremely low birth weight (ELBW) babies to reduce donor exposure (DE) from blood transfusions.1 However, concentration of transfusions at the beginning and end of neonatal care coupled with short shelf-life of blood result in wastage of SPs and unavoidable DE. Neonatal transfusion practice may have changed due to restrictive transfusion guidelines, micro-sampling methods and practice of delayed cord clamping. We currently reserve only 4 SPs for ELBW babies and strictly follow British Committee for Standards in Haematology 2004 guidelines for blood transfusion2.

Aims To ascertain the root cause of excess DE and SP wastage in multi-transfused ELBW babies and suggest an optimum contemporary strategy that would balance DE with SP wastage.

Methods Transfusion data was collected for all inborn ELBW babies and those transferred-in within 96 hours of birth in 2010. Rates and determinants of DE were analysed. Projected SP wastage and DE rates were calculated for different SP strategies.

Results Thirty-eight ELBW babies with a mean gestation of 25.5 weeks and birth weight of 712 grams were included. Eight babies were not transfused while 7 received only one transfusion. Therefore, 23 babies were included for DE and 30 for SP wastage analysis. The mean SP usage was 3.97/baby. The mean DE was 2.47 and mean SP wastage 4.7/baby. The mean age of the donor unit at allocation was 20.2 days (95% CI 18.4, 22). The mean interval between the first and last transfusion was 35 days. Reducing donor unit age to 14 days at allocation would have reduced one donor exposure in 11/23 babies (47.8%). Table 1 shows the effect of different projected SP strategies on DE and SP wastage.

Conclusions Younger age of blood unit at allocation is the key to reduce DE. A 4-SP strategy appears appropriate for current transfusion practice for ELBW babies.

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