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BLOOD COMPONENT THERAPY in the Newborn

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.

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BLOOD COMPONENT THERAPY in the Newborn

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  1. BLOOD COMPONENT THERAPY in the Newborn Amit Ray Kolkata

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. FFP • Used to replace coagulation factors • 10-15 ml/kg • may repeat 12-24hrly • NOT indicated for vol expansion

  8. 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

  9. 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

  10. 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

  11. 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

  12. Whole blood • Rarely required • Ind.– blood loss, cardiac surgery, exchange Tx

  13. 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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