Risks and Benefits of Blood Product Transfusions in Neonates

Blood products can be used to replace blood or particular components of the blood that have been lost by injury or illness.

All blood products are obtained from blood collected from volunteer blood donors.

Blood may be processed into these various blood components:

Packed Red Blood Cells (PRBC)

Red blood cells carry oxygen to the tissues. Packed red blood cells have had most of the plasma removed from the whole blood. Packed cells are usually given into a vein over two to four hours.

The most common reasons for PRBC transfusion in the Newborn Intensive Care Unit are:

  • Anemia due to prematurity
  • To replace red blood cells lost during surgery or a procedure

Whole Blood

Whole blood contains red blood cells and plasma. It is sometimes used for exchange transfusions (complete replacement of a baby's blood) in newborns with elevated bilirubin levels. This product is otherwise not commonly used.

Platelets

Platelets are cell fragments that prevent or stop bleeding or bruising by physically plugging holes in blood vessels. Platelet transfusions may be needed if an infant's platelet count is too low. Platelets are given into a vein.

Fresh Frozen Plasma

Fresh frozen plasma is plasma that was frozen and stored shortly after it was obtained from the blood donor. Fresh frozen plasma contains many clotting factors and is often used alone or with cryoprecipitate to replace the low levels of clotting factors. It is given into a vein.

Cryoprecipitate

Cryoprecipitate is the part of the blood that contains only certain clotting factors such as factor VIII (deficient in hemophilia A), von Willebrand factor and fibrinogen. Cryoprecipitate along with fresh frozen plasma (see above) may be given to help replace the clotting factors that are low. Cryoprecipitate is given into a vein.

Other blood products are rarely if ever used in the NICU. If this does occur, your baby's physician will discuss it with you.

Blood product transfusions save lives or improve the patient's condition. For NICU patients, blood transfusions ensure that adequate oxygen delivery is maintained for vital organs. This is crucial for appropriate growth and development.

The number of patients who die or become seriously ill from a blood product is very small when compared to the benefits of blood products to the patients who receive a transfusion.

The types of possible individual adverse effects of transfusions are discussed below. Additional information can be obtained from your baby's physician.

Immune-Mediated

Immune-mediated adverse reactions are those caused by a reaction of the patient's immune system against the blood product or a reaction of the immune cells in the blood product against the patient. These are rarely, if ever, observed in the newborn intensive care setting. The most common transfusion reaction is a fever shortly after the transfusion. Filtration of blood products prior to transfusion significantly decreases this risk. Cellular blood products used at Cincinnati Children's Hospital Medical Center are routinely filtered.

Viruses

Some viruses can be transmitted through transfusion. Cytomegalovirus (CMV) is one virus easily transmitted through transfusion. Patients with severe immunosuppression are at risk for getting CMV and may develop severe complications including pneumonia. Using blood products that have been filtered to remove white blood cells, have been frozen, or that have been tested as negative for antibodies to CMV reduces the risk of getting CMV through transfusion. These products are referred to as "CMV safe." We use only CMV safe blood products in the NICU.

Viruses such as the hepatitis viruses (hepatitis B and hepatitis C) and the viruses associated with AIDS can be transmitted through transfusion. The risk is very rare due to the extensive testing of the blood products before they are released for transfusion. The risk of hepatitis B can be reduced by the use of hepatitis B vaccine in all patients who receive blood transfusions.

Infections

Parasitic infections from blood products in the United States are very uncommon.

There is general information available regarding the risk of transfusion reaction or infection from a blood transfusion. However, no large studies have focused upon the neonatal intensive care unit population. Smaller studies suggest that the risk from adverse reactions or infection is as low or lower than the general population.

Additional general statistical information about blood transfusion risks can be obtained from your baby's physician and internet sites:

There are limited alternatives for blood transfusion in the newborn intensive care unit. Our most effective approach is to order blood transfusions only when they are medically indicated. We make use of limited donor exposure protocols to further reduce risk of infection or transfusion reaction.

Directed donor blood is rarely used in the newborn intensive care unit because of the time needed for screening and processing.

A medication called erythropoietin (Epogen) has been used with some success to reduce the need for packed red blood cell transfusions in the newborn intensive care unit. However, some studies show it no more effective than prudent transfusion guidelines. Furthermore, the long-term safety of Epogen has not been thoroughly studied in the NICU patient population.

There are no useful alternatives for the use of platelets, fresh frozen plasma, or cryoprecipitate.


Last Updated 12/2013