BLOOD-COMPONENT-THERAPY-in-the-Newborn

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					BLOOD COMPONENT
THERAPY in the Newborn

         Amit Ray
         Kolkata
   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
   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 newborn-
Guidelines
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
   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
   Immune response mounted by donor T-
    cells 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
   Used to replace coagulation factors
   10-15 ml/kg
   may repeat 12-24hrly
   NOT indicated for vol expansion
Indications for FFP
   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
   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
   < 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
   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
   Rarely required
   Ind.– blood loss, cardiac surgery,
    exchange Tx
Conclusions
   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.

				
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posted:11/30/2009
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