Transcript BLOOD COMPONENT THERAPY in the Newborn

BLOOD COMPONENT
THERAPY in the Newborn
Amit Ray
Kolkata
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Of all patient groups preterm infants
are one of the most frequently
transfused
Unique features of neonates: immature
immune system, difficult to cope with
metabolic load, presence of mat Ab’s
Current trends
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More aware of risks of Tx: AIDS epidemic;
other infections e.g. CMV, HBV, HCV, Parvo,
malaria; ROP; TAGVHD
Window period: HBsAg 59 days
Scarce commodity
Hence RESTRICT no of transfusions, avoid
unnecessary sampling, Micro-techniques,
noninvasive monitoring, rhEPO
RBC Tx in newbornGuidelines
1 PCV < 20, low Retics, symptoms
2 PCV < 30, with
<35% Hbox O2, nasal O2, CPAP or IMV
(map 6), >6 apnea/brady in12h req
bagging, HR >180 x 24h, RR >80 x 24h
3 PCV<35 with >35% O2 by Hbox or CPAP/IMV
(map 6-8)
4 PCV <45 with cong cyan ht ds
RBC Tx
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Small vol Tx with Packed RBC
concentrate (PCV 70-90)
Preservative CPD, AS-3
Infuse over 2-4 h, Dose 15 ml/kg
2,3 DPG >70% in 1st 5 days
TAGVHD
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Immune response mounted by donor Tcells against host tissues
fatal syndrome—wasting, dermatitis,
hepatitis, GIT sympt., marrow
suppression, high fever by 4 days of tx
Fresh blood < 96 h old a risk factor
Irradiation of blood from immediate
relatives– imp for large vol Tx only
FFP
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Used to replace coagulation factors
10-15 ml/kg
may repeat 12-24hrly
NOT indicated for vol expansion
Indications for FFP
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HDN with sign. Haemorrhage
Isolated factor deficiency
Replacement in AT III, prot C or S def.
DIC
Bleeding following massive transfusion
Therapeutic plasma x’change in TTP
Platelet concentrate
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From centrifugation of whole blood
Final conc 85% (50-70 lakh/cu.mm)
Some white cells inevitably present
1 unit of random donor raises plt count
to >1lakh/cu.mm, by infusing 5-10
ml/kg of std platelet conc.
Plt shd be Rh & ABO specific
Guidelines for Plt Tx
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< 30k in term NB with failure of production
< 50k in stable prem with active bleed or
invasive procedure in DIC pt
<1 lakh in sick prem with active bleed or
invasive procedure in DIC pt
Active bleed in pt of Plt Quality defect
Unexplained x’cessive bleed in cardio-pulm
bypass
ECMO with plt < 1lakh or with bleeding
Granulocyte Tx
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Possible role in sepsis in conjunction
with antibiotics
Optimal use yet to be established
Only useful if obtained by leukopheresis
Must be irradiated
Whole blood
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Rarely required
Ind.– blood loss, cardiac surgery,
exchange Tx
Conclusions
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RBC Tx remains an essential part of
mge of hi risk prems
Focus on prev of anaemia, donor
restriction and restriction of no of TX
Be aware of the potential for harm esp
infections. Avoid unnecessary Tx.